52例HBeAg阴性HBV相关性肝细胞癌患者的临床分析

Clinical analysis on 52 patients with HBeAg (-) and HBV-related hepatocellularcarcinoma

目的通过对HBeAg阴性慢性乙型肝炎进展为肝癌（HCC）患者的临床资料进行回顾性分析，探讨该病的发生规律和临床特征。方法对本院收治的52例HBeAg阴性HCC患者的性别、年龄、生化学指标、HBVDNA载量、免疫学状态以及服药情况等进行综合分析并进行统计学处理。结果52例HBeAg阴性HCC患者的血清HBVDNA分布：〈10^3 拷贝／ml者18例（34．63％），10^3～10^5拷贝／ml者22例（42．30％），〉10^5拷贝／ml者12例（23．07％）。血清HBVDNA载量愈高的患者肝损伤愈重。抗-HBe（-）／抗HBe（＋）和抗-HBs（-）/抗-HBS（＋）不同血清HBVDNA的分布无相关性，HCC的发生与抗-HBe和抗-HBs是否出现无关。经抗病毒药物治疗的HCC发生例数显著低于未使用过药物者，提示抗病毒药物能降低或延缓HCC的发生。结论对于HBeAg阴性慢性乙型肝炎患者，尤其是有重症化和肝硬化病理基础、年龄偏大的患者，其HBeAg转阴可能是在药物作用下实现的自然血清学转换伴HBvDNA水平下降至正常，甚至有患者出现HBSAg阴转；也可能是病毒发生变异所致；此两类患者均应警惕HCC的发生。

Objective To analyze the clinical data of hepatocellular carcinoma progressed from HBeAg negative chronic hepatits B patients, retrospectively, and discuss the occurring pattern and clinical features. Methods Total of 52 cases with HBeAg negative hepatocellular carcinoma admitted in our hospital were enrolled gender, age, biochemistry indexes, HBV DNA load, immunology and medication compliance of these 52 patients were analyzed comprehensively and statistically. Results Among the 52 HBeAg negative HCC patients, 18 cases （34.63%） serum HBV DNA 〈 103 copies/ml, 22 cases （42.30%） 103-105 copies/ml, 12 cases （23.07%） 〉 105 copies/ml liver damage were worse in patients with higher serum HBV DNA load. Anti-HBe （--）/anti-HBe （＋） and anti-HBs （--）/ anti-HBs （＋） in different distribution had no significant correlation with serum HBV DNA, while the occurrence of anti-HBe and anti-FIBs had no significant correlation with HCC. Patients with HCC in antiviral therapy group were significantly less than untreated cases, indicating that antiviral drugs could reduce or delay the procession of HCC. Conclusions Among patients with chronic hepatitis B of HBeAg negative, especially with liver pathological basis such as cirrhosis, older patients, HBeAg undetected may be realized due to HBeAg natural seroconversion and HBV DNA normalization, some patients even ouccured HBeAg undetected, which also could be caused by virus mutation. This two kinds of patients should be alert to the occurrence of HCC.