抗病毒疗法对慢性乙型肝炎患者肝癌发病的影响

Effect of nucleos(t)ide analog antiviral treatment on occurrence of hepatitis B virus-associated hepatocellularcarcinoma

目的:探讨抗病毒疗法对慢性乙型肝炎(chronic hepatitis B,CHB)患者肝癌发病的影响,为CHB患者肝癌发生研究提供可参考依据.方法:选择2009-12/2013-12南阳市中心医院感染性疾病科240例诊断为CHB患者作为研究对象,采用随机数字法平均分为抗病毒治疗组与未抗病毒治疗组,比较肝癌发生情况.同时分析肝硬化对肝癌发生的影响.结果:随访2年后抗病毒组肝癌发生10例(8.3%),明显低于未抗病毒组21例(17.5%),差异有统计学意义(P<0.05).无肝硬化患者行抗病毒治疗后肝癌发生率明显低于未抗病毒治疗患者,差异有统计学意义(3.1%vs20.0%,P<0.05);而肝硬化患者抗病毒治疗与未抗病毒治疗,肝癌发生率比较差异无统计学意义(14.3%vs 15.7%,P>0.05).抗病毒治疗后无肝硬化组患者肝癌发生率明显低于肝硬化组,差异有统计学意义(3.1%vs 14.3%,P<0.01);非肝硬化组乙型肝炎e抗原(hepatitis Beantigen,H Be Ag)-患者肝癌发生率高于H B e A g+患者,差异有统计学意义(0.0%vs9.1%,P<0.05).结论:抗病毒治疗可以有效降低CHB患者肝癌发生率,对HBe Ag+的无肝硬化发生患者疗效更明显.

AIM： To explore the effect of nucleos（t）ide analog antiviral treatment on the occurrence of hepatitis B virus （HBV）-associated hepatocellular carcinoma. METHODS： Two hundred and forty patients diagnosed with chronic hepatitis B at our hospital from December 2009 to December 2013 were divided into an antiviral treatment group and a non-antiviral treatment group. The incidence of liver cancer was compared between the two groups. The effect of cirrhosis on the incidence of liver cancer was also analyzed. RESULTS： The incidence of liver cancer in the antiviral treatment group was significantly lower than in the non-antiviral treatment group （8.3% vs 17.5%, P 〈 0.05）. The incidence of liver cancer in non-cirrhosis patients receiving antiviral treatment was significantly lower than that in non-cirrhosis patients without antiviral treatment （3.1% vs 20.0%, P 〈 0.05）. There was no difference between cirrhosis patients with and without antiviral treatment （14.3% vs 15.7%, P 〉 0.05）. The incidence of liver cancer in non-cirrhosis HBeAg^- patients was significantly higher than that in non-cirrhosis HBeAg^＋ patients （0.0% vs 9.1%, P 〈 0.05）. CONCLUSION： Antiviral treatment can effectively reduce the incidence of liver cancer in chronic hepatitis B patients, especially non-cirrhosis HBeAg^＋ patients.