HBV相关性肝癌射频消融和手术切除术后HBV激活率的比较

Hepatitis B reactivation after treatment for HBV-related hepatocellular carcinoma: comparative analysis of radiofrequency ablation versus hepatic resection

目的 探索HBV相关性肝癌射频消融术后HBV的激活率及其影响因素,并与手术切除比较. 方法 回顾性分析2008年8月至2011年8月临床诊断为HBV相关性肝细胞癌218例,射频消融术(射频组)125例,手术切除(手术组)93例,分析比较两组患者的HBV激活率及其影响因素.射频组和手术组之间的计量资料均数比较采用t检验或秩和检验,计数资料采用x2检验或Fisher's精确概率法检验；HBV激活率的影响因素通过logistic回归分析进行单因素和多因素分析.结果 218例患者中20例出现HBV激活,射频组7例(7/125,5.6％),手术组13例(13/93,14.0％),射频组的HBV激活率低于手术组,差异有统计学意义(x2=4.492,P＜ 0.05).单因素和多因素分析显示抗病毒治疗(OR=11.7,95％可信区间为1.52～90.80,P＜0.05)和不同治疗方式(射频/手术)(OR=3.36,95％可信区间为1.26 ～ 8.97,P＜0.05)是HBV激活的独立危险因素；亚组分析:抗病毒治疗的患者HBV激活率均低于未抗病毒治疗患者(1/68与19/150,x2=7.039,P＜ 0.01),但在射频组内抗病毒与否和HBV激活率差异无统计学意义(0/33与7/92,x2=2.660,P＞ 0.05);而手术组内未抗病毒治疗的HBV激活率明显升高(1/35与12/58,x 2=5.773,P＜0.05).结论 HBV相关性肝癌射频术后会发生HBV的激活,其激活率低于手术切除；手术切除前抗病毒治疗可以降低术后HBV的激活率.

Objective To perform a comparative analysis of the reactivation rate of hepatitis B virus (HBV) infection and related risk factors after treatment of HBV-related hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA) or hepatic resection.Methods We retrospectively analyzed the HBV reactivation rate and related risk factors of a cohort of 218 patients treated for HBV-related HCC between August 2008 and August 2011; the study population consisted of 125 patients who received RFA and 93 patients who received hepatic resection.Comparisons were made using the unpaired Student's t-test for continuous variables and the x2-test and Fisher's exact test for categorical variables.Univariate and multivariate logistic regression analysis was used to assess risk factors.Results Twenty patients showed HBV reactivation following treatment,but the incidence was significantly lower in the RFA group than in the hepatic resection group (5.6％ vs.14.0％,7/125 vs.13/93,x2 =4.492,P =0.034).The univariate and multivariate analysis indicated that no antiviral therapy (OR =11.7; 95 ％ CI:1.52-90.8,P =0.018) and the treatment type (i.e.RFA or hepatic resection) (OR =3.36; 95％ CI:1.26-8.97,P =0.016) were significant risk factors of HBV reactivation.Subgroup analysis showed that the incidence of HBV reactivation was lower in patients who received antiviral therapy than in those who did not for both the RFA group and the hepatic resection group but the difference was not significant in the former group (1/68 vs.19/150,x2=7.039,P =0.008 and 0/33 vs.7/92,x2 =2.660,P =0.188,respectively).However,the incidence of HBV reactivation in patients who did not receive antiviral therapy was higher than in those who did receive antiviral therapy in the hepatic resection group (12/58 vs.1/35,x2 =5.773,P =0.027).Conclusion The incidence of HBV reactivation was lower in patients who received RFA than in those who received hepatic resection to treat HBV-related HCC.Antiviral therapy prior to the hepatic resection treatment may be beneficial for reducing the incidence of HBV reactivation.