与乙型肝炎病毒相关的原发性肝细胞癌肝移植术后的临床观察

Clinical analysis of the recurrence of Hepatitis B Virus-associated hepatocellular carcinoma after the orthotopic liver transplantation

目的探讨与乙型肝炎病毒(HBV)相关的原发性肝细胞癌(HCC)患者在肝移植术后肿瘤复发与乙型肝炎复发之间的相关关系。方法以52例与HBV相关的HCC患者为研究对象,回顾性分析这些患者的临床资料,根据肝移植后有无肿瘤复发,将患者分为肿瘤复发组(12例)和无肿瘤复发组(40例)。探讨两组间临床和病理特征的差异。结果在肿瘤复发组中,有10例患者的血清HBV表面抗体(抗-HBs)消失,其中4例在随访期间未发现HBV表面抗原(HBsAg)转阳,6例出现HBV表面抗原转阳。这6例患者首先表现为血清HBV免疫球蛋白(HBIg)药物浓度明显下降或消失,继而出现抗-HBs转阴,HBsAg转阳,2例患者的HBV-DNA复制呈阳性。而同期无肿瘤复发组的40例患者抗-HBs呈阳性,无HBsAg转阳。结论肝癌细胞染色体中存在整合的HBV- DNA,随着转移性肝癌细胞的增殖,HBV大量复制,最终出现乙型肝炎复发。

Objective To discuss the relationship between the hepatitis B virus （HBV）-associated hepatocellular carcinoma （HCC） recurrence and HBV re-infection after the orthotopic liver transplantation （OLT）. Methods Fifty-two HBV-associated HCC patients receiving OLT were followed up, their clinical data were retrospectively analyzed, and they were divided into two groups by the way whether HCC recurred （12 cases） or not （40 cases）. The clinical and pathological differences between two groups were investigated. Results In HCC recurrent group, serum surface HBV antibody （anti- HBs） disappeared in 10 cases. During the period of follow-up, no recurrence of surface HBV antigen （HBsAg） was found in 4 cases, and the remaining 6 cases had recurrence of HBsAg. Among the 6 cases, serum HBV immunoglobulin levels were significantly reduced or disappeared, followed by negative anti-HBs and positive HBsAg, and 2 cases were positive for HBV-DNA replication. In no-recurrent HCC group, all 40 cases were positive for anti-HBs and had no recurrence of HBsAg. Conclusion Integrated HBV-DNA existed in the HCC chromosomes, with the proliferation of the metastatic HCC cells, a great deal of HBV-DNA was replicated and finally HBV recurred.