原发性肝癌患者围手术期乙型肝炎病毒DNA的变化及其影响因素

Changes in perioperative level of hepatitic B virus DNA in patients with hepatocellular carcinoma and their influences

目的探讨乙肝相关性肝癌患者围手术期乙型肝炎病毒（HBV）DNA水平变化的影响因素，比较抗病毒治疗与未抗病毒治疗对患者术后肝功能恢复的影响。方法选择55例未达到抗病毒治疗标准的乙肝相关性肝癌患者，定量检测其术前和术后第3天的HBVDNA载量及白细胞介素（IL）-6、IL-10、IL-27的水平。根据术后HBV DNA载量，将患者分成HBV DNA升高（激活）组和不变组。升高组给予抗病毒治疗。记录所有患者术前、术后肝功能指标。用SPSS13．0进行统计学分析。结果（1）全组患者HBV激活率为45％（25／55），术前HBV DNA〈1×10^4IU／ml的患者，术后HBV激活占激活总数的76％（19／25）。（2）Logistic回归分析显示肿瘤直径（P=0．037，0．006）及肝切缘无水酒精注射（P=0．004）是引起HBV再激活的独立危险因素。（3）酶联免疫吸附测定（ELISA）结果：术后IL-10升高与HBV再激活有关（P=0．001），IL-6升高及IL-10降低与HBV不变有关（P=0．000）。（4）术后HBV DNA升高且行抗病毒治疗的患者，术后肝功能恢复情况与其他患者比较差异无统计学意义（P〉0．05）。结论肝癌切除术可能引起患者HBV再激活，围手术期内应监测HBV DNA载量的变化。肿瘤直径、术中行肝切缘无水酒精注射术是HBV再激活的独立危险因素。患者术后IL-10、IL-6水平的变化可能与HBV DNA的变化有关。术后HBV再激活近期不会加重肝功能损伤，术后抗病毒治疗对患者近期肝功能的恢复无明显促进作用。

Objective To investigate the influences in perioperative variations in serum levels of hepatitis B virus （HBV） DNA in patients with HBV related hepatocellular carcinoma （HCC）, and to observe the differences in postoperative recovery of liver function between the antiviral treatment group and the non-antiviral treatment group of patients. Methods From Feb. 2012 to Nov. 2012, 55 patients whose preoperative serum levels of HBV DNA were below the recommended level of antiviral treatment were included into the study. The serum levels of HBV DNA, IL-6, IL-10 and IL-27 preoperatively and on postoperative day 3 were measured. Using the postoperative serum levels of HBV DNA, the patients were divided into 2 groups： the high level group and low level group. Patients in the high level group received antiviral treatment, but the low level group did not. The changes in preoperative and postoperative liver function and other data of the patients were recorded and analyzed by the SPSS 13.0 software. Results （1） The reactivation rate of serum HBV DNA in the HBsAg-positire HCC patients was 45% （25/55）. In patients with a preoperative HBV DNA level 〈 1× 10^4 IU/ml the postoperative HBV reactivation rate was up to 76% （19/25）. （2） Logistic regression analysis showed tumor diameter （P=0. 037, 0. 006） and injecting anhydrous alcohol into the resection margin （P=0. 004） were independent risk factors of postoperative HBV reactivation. （3） Postoperative serum IL-10 elevation was associated with HBV reactivation （P=0. 001）. On the contrary, serum IL-6 level elevation was associated with HBV reactivation （P〈0.01）. （4） When compared with the low level group, postoperative serum alanine aminotransferase, total bilirubin and albumin in the high level group showed no significant difference （P〈0.05）. Conclusions Hepatectomy could reactivate HBV replication during the perioperative period. A close monitoring of HBV DNA during the perioperative period was necessary, especially in patients with low HBV DNA levels. The tumor diameter and injecting anhydrous alcohol into the resection margin were independent risk factors of postoperative increase in HBV DNA. Changes in serum IL-10 and IL-6 levels after hepatic resection might be related to the elevation of HBV DNA level. In addition, reactivation of HBV did not aggravate damages in postoperative liver function. Antiviral treatment did not promote recovery of liver function in the early stage.