慢性乙肝患者口服核苷（酸）类似物治疗后发生肝癌的病例特点

Hepatocellular carcinoma in patients with chronic hepatitis B treated with nucleos（t） ide analogues

目的 探讨慢性乙型肝炎患者口服核苷（酸）类似物后新发肝癌患者的临床特点,以指导临床实践.方法 收集2007年1月～ 2011年12月我院门诊就诊的慢性乙型肝炎病毒感染患者458例,均口服核苷（酸）类似物超过半年并密切随访,新发肝癌20例.对20例患者的临床资料进行分析.结果 20例新发肝癌患者均通过B超筛查,核磁共振成像（MRI）或CT扫描诊断为肝癌,诊断肝癌时均有肝硬化基础.其中,获得持续病毒学应答11例,持续生化学应答16例,血清甲胎蛋白（AFP）水平正常11例.肝癌患者Child-Pugh评级为A级15例,B级5例.结论 口服核苷（酸）类似物抗病毒治疗的慢性乙型肝炎患者,即使持续生化学及病毒学应答、AFP检测正常仍有可能发生肝癌,规范B超等影像学随访可以早期诊断、及时治疗及获得良好预后.

Objective To guide our clinical practice, we described and analysised 20 patients with hepatocellular carcinoma （ HCC ） and chronic hepatitis B treated with nucleos （t） ide analogues （NUCs）. Methods From January of 2007 to December of 2011, we treated 458 chronic hepatitis B patients with NUCs for over six months and observed 20 patients suffered with HCC. We colleted their clinical history and laboratory examination. Results We diagnosed HCC by uhrasonography and magnatic resonance imaging（MRI） or computed tomography. When HCC was diagnosed, cirrhosis was present in all patients and 11 patients got sustained virological response and 16 patients got sustained biochemical response, 11 of them had normal alpha-fetoprotein （AFP） level. 15 patients were classified Child-Pugh A class and the other 5 patients were B class. Conclusion In patients with chronic hepatitis B treated with NUCs,HCC can happen even they have gotten sustained virological response or sustained biochemical response, or normal AFP level. But those developed to HCC are mostly treatable and favorable prognosis as soon as they were regularly follow-up with ultrasound examination or other imaging techniques.