X线立体定向适形放疗对肝癌伴HBV感染者肝功的损伤

The liver damage induced by X-ray 3-dimensional conformal radiotherapy in liver cancer patients of different HBV infection state

目的研究具有HBV不同感染状态的肝癌,在6mv-X线立体定向适形放射治疗后对肝组织的放射性损伤。方法选择肝癌体积,放疗剂量基本相似条件下,将HBVM(乙肝病毒标志物)阳性肝癌与阴性肝癌分为两组,同时在阳性组内以其HBVM不同表达形式再分4组:以ALT(丙氨酸转移酶)为指标观察具有HBV不同感染状态肝癌于放疗后发生肝损伤的危险性。结果HBVM(+)肝癌于放疗后ALT上升值与放疗前比较具有显著性差异(P<0.01),HBVM(+)肝癌与HBVM(-)肝癌于放疗后ALT升、降之差及上升率比较,差异非常显著(P<0.001,P<0.01)。同时发现放疗对HBVM(+)组中HBsAg、HBeAg、HBcAb(+)者的肝癌,发生放射性肝损伤的危险性最高;而HBsAg和HBcAb、HBcAb(+)者无明显肝损伤,两者比较差异非常显著(P<0.001);与HBVM(-)肝癌比较亦有非常显著性差异(P<0.001)。结论全部肝癌患者在X线立体定向适形放射治疗中发生放射性肝损伤者占45.71%,而在HBVM阳性者中占88.88%,其中以HBsAg、HBeAg、HBcAb(+)的肝癌患者发生肝损伤的程度较重,其次是HBsAg、HBeAb、HBcAb(+)者。而HBcAb、HBeAb(+)者和单项HBsAg(+)者无明显肝损伤。

Objective To research the radiation damage of liver induced by X-ray 3-dimensional conformal radiotherapy (3-DCRT) in the patients with liver cancer of different HBV infection state. Methods Based on HBV-Markers (HBVM) liver cancer patients were classified into two groups: positive cancers and negative cancers, with their having the same volume and roughly the same dose by 3-DCRT. The positive group is subdivided into four groups according to HBVM's different manifestations.With ALT as the index,poten-tiality of liver danger in liver cancer of different HBV infection state after 3-DCRT was observed.Results The ALT value of HBVM(+) liver cancer increased distinctly after 3-DCRT(P<0.001). The difference between the increment of ALT of HBVM(+) liver cancer and the decrement of ALT of HBVM(-) liver cancer after radiotherapy was very notable compared with the rate of increment (P<0.001,P<0.01). At the same time, in the HBsAg,HBeAg,HBcAb(+)liver cancer was the highest, the radiation damage induced by 3-DCRT while the HBsAg,HBcAb,HBeAb(+)was undistinct. The difference of the above two subgroups of liver cancer was very apparent (P<0.001,OR=27.42), and the differences between them and the HBVM(-) liver cancer were also very noticeable (P<0.001,OR=28.68). Conclusions The cases with the radiation damage induced by 3-DCRT account for 45.71% of all the cases. Within the HBVM(+) groups, the percentage is 88.88%, with the patients with the HBsAg,HBeAg,HBcAb(+)liver cancer suffering from the greatest liver damage, the HBsAg,HBcAb,HBeAb(+) from the secondary, and the HBcAb,HBeAb(+) together with the single HBsAg(+), non-apparent.