HBV-DNA阳性肝细胞癌患者抗病毒治疗的临床意义

The clinical significance of antiviral therapy for hepatocellular carcinoma with positive HBV-DNA patients

目的分析抗乙肝病毒(HBV)治疗对于HBV-DNA阳性并行手术切除的肝细胞癌(HCC)患者预后的影响。方法回顾性分析2007年1月～2012年12月安徽医科大学第一附属医院肝胆外科HBV DNA≥103copies/ml且行肝癌切除术的HCC患者共68例,按在围手术期及术后是否行正规抗HBV治疗分为未抗病毒组(33例)及抗病毒组(35例)。抗病毒方案为拉米夫定/阿德福韦酯二联方案或恩替卡韦单药治疗。比较两组间临床病理学参数,术后1周、1个月及3个月的血清HBV DNA含量,术后整体生存时间及无瘤生存时间的差异。结果两组患者临床病理学参数及术前血清HBV DNA含量无明显差异(P>0.05),抗病毒组HBV DNA术后明显降低,而未抗病毒组HBV DNA持续处于高水平,两组间有显著性差异(P<0.05)。抗病毒组术后总体生存时间明显高于未抗病毒组(33.65±5.43月vs 15.64±2.48月),未抗病毒组术后无瘤生存明显少于抗病毒组(12.43±1.90月vs 24.51±4.44月)。结论针对HBV-DNA阳性HCC患者行正规抗病毒治疗可有效降低血清HBV-DNA含量,延长术后总体生存时间及无瘤生存时间。

Objective To investigate the effect of anti hepatitis B virus treatment to the prognosis of patients accepted hepatectomy with hepatocellular carcinoma combined positive expression of HBV DNA. Methods Analysed patients accepted hepatectomy with hepatocellular carcinoma combined positive expression of HBV DNA in General Surgery Department of 1st Affiliated Hospital of Anhui Medical University from January 2007 to December 2012. Totally 68 patients were divided into non - antiviral group （33 cases） and antiviral group （35 cases） which protocol was lamivudine ＋ adefovir or entecavir alone. The clinical/pathological parameters, HBV DNA level in serum, postoperative total and tumor free survival time were compared in these two groups respectively. Results The clinical/pathological parameters and preoperative HBV DNA level in two groups didn＇ t show the significant difference （ P 〉 0. 05 ）, while postoperative HBV DNA level in antiviral group was decreased significantly than in non-antiviral group （ P 〈 0. 05 ）. The patients in antiviral group had a significantly greater total and tumor free survival time than in non-antiviral group after hepatectomy. Conclusion The anti hepatitis B virus treatment can decrease the HBV DNA level in serum and prolong the total and tumor free survival time in patients with hepatocellular carcinoma combined positive expression of HBV DNA after hepatectomy.