核苷类似物抗病毒治疗后HBeAg(-)/(+)患者肝癌发生的临床观察

Clinical observation of the incidence of hepatocellular carcinoma in HBeAg(-)/(+) chronic hepatitis B patients with nucleoside analogue therapy

目的评估长期使用核苷类似物抗病毒治疗的慢性乙型肝炎患者肝癌发生与HBeAg(-)/(+)之间的关系。方法回顾性分析2006年09月至2012年10月于该院门诊开始进行核苷类似物抗病毒治疗的排除肝癌的慢性乙型肝炎751例,各危险因素对肝癌发生的影响。所有分析对象均接受抗病毒治疗满5年。结果在长期接受核苷类似物抗病毒治疗的慢性乙型肝炎患者中,肝癌总发生率为5.19%,无肝硬化HBeAg(+)的患者发生肝癌1.91%,无肝硬化HBeAg(-)的患者发生肝癌5.31%,HBeAg(-)的慢性乙型肝炎(无肝硬化)患者肝癌发生比例明显升高。结论慢性乙型肝炎患者长期进行核苷类似物抗病毒治疗可降低但不能消除肝癌发生的危险,HBeAg(-)是慢性乙型肝炎(无肝硬化)患者肝癌发生的危险因素。

Objective To evaluate the correlation between hepatocellular carcinoma incidence and HBeAg（-）/（＋） in chronic hepatitis B patients with long-term nucleoside analogue therapy. Methods A retrospective study included 751 chronic hepatitis B patients with long-term nucleoside analogue therapy from September 2006 to October 2012 in this hospital. HBeAg（-） and HBeAg （＋） were selected to evaluate the incidence of hepatocellular carcinoma. All subjects underwent anti-viral therapy with no less than five years. Results The total incidence of hepatoeellular carcinoma was 5.19% ,and the incidence in HBeAg（＋） chronic hepatitis B patients （without liver cirrhosis） was 1.91%, while the incidence in H BeAg（-） patients was 5.31%, and the incidence of hepato-cellular carcinoma was much higher in patients（without liver cirrhosis） of HBeAg（ - ）. Conclusion Long term therapy with nuele osides can reduce but not eliminate the hepatocellular carcinoma risk in patients with chronic hepatitis B, especially those with HBeAg（-）. HBeAg negativity is a significant risk factor for the development of hepatocellular carcinoma in chronic hepatitis B pa tients （without liver cirrhosis）.