肝细胞癌患者术前HBV DNA含量对术后肝功能影响的初步研究

Effects of hepatitis B virus DNA level on postoperative hepatic function in patients with HCC

目的探讨肝细胞癌(HCC)患者术前HBV DNA含量对切除术后肝功能恢复的影响。方法收集我科2007年1月至2007年6月行手术切除治疗的原发性肝癌患者共217例,应用实时荧光定量PCR方法检测血清中HBV DNA,按照HBV DNA含量分为两组:A组(HBV DNA≥1.0×105拷贝/ml)68例,B组(HBV DNA<1.0×105拷贝/ml)149例。严密观察患者术后肝功能变化情况,采用SPSS13.0软件进行统计分析。结果术后两组患者的肝功能变化存在着显著差异,A组的肝功能损伤程度高于B组。术后第1、3、7天,丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)数值A组明显高于B组,而前白蛋白数值则B组高于A组,两组差异有统计学意义(P<0.05);术后第3、7天,总胆红素(TBIL)数值A组明显高于B组,两组差异有统计学意义(P<0.05)。除术前凝血酶原时间(PT)、前白蛋白、TBIL、AST和术中肝门阻断时间外,术前HBV DNA浓度对术后第7天的血清TBIL水平有显著影响。结论HCC患者术前HBV DNA含量对于术后肝功能恢复有明显影响,对术前HBV DNA含量较高的患者应在治疗肝癌的同时给予抗病毒治疗。

Objective To explore short-term effects of serum hepatitis B virus DNA level on hepatic function in patients who underwent hepatectomy of HCC.Methods Clinical data of 217 patients with HCC undergoing hepatectomy between Jan.2007,to Jun.2007,were retrospectively analyzed.Patients were divided into two groups with group A（n=68）in which the hepatitis B virus DNA level was higher than 105 copies/ml,and group B（n=149）in which the level was lower than 105 copies/ml.The changes of postoperative hepatic function in two groups were compared.Results There were significant difference between two groups,including postoperative prealbumin,ALT,AST,TBIL（d3 and d7 after operation）.While there were no significant difference between two groups,including postoperative albumin and TBIL（d1 after operation）.The multivariate logistic regression analysis revealed that the hepatitis B virus DNA level negatively effected the level of TBIL（d7 after operation）.Conclusion The hepatitis B virus DNA level has a significantly positive influence on postoperative hepatic function.So the patients whose hepatitis B virus DNA level are too high preoperatively should receive antiviral therapy,meanwhile.