肝动脉化疗栓塞联合恩替卡韦治疗乙型肝炎相关性原发性肝细胞癌的疗效及其对炎性因子和免疫功能的影响

Clinical effects of combination of transcatheter arterial chemoembolization and entecavir on hepatitis B virus associated primary hepatocellular carcinoma and their influence on inflammatory factors and immune function

目的探讨肝动脉化疗栓塞联合恩替卡韦治疗乙型肝炎相关性原发性肝细胞癌的疗效及其对炎性因子和免疫功能的影响。方法选取84例乙型肝炎病毒相关性原发性肝细胞癌患者为研究对象,按照治疗方式的不同分为肝动脉化疗栓塞联合恩替卡韦治疗组（联合组）和单独肝动脉化疗栓塞治疗组（单独组）,每组42例。比较两组治疗方式的近期和远期临床疗效及其对炎性因子和免疫功能的影响。结果联合组的治疗有效率高于单独组（χ~2=10.868,P=0.001）;两组患者疾病控制率和不良反应发生率差异元统计学意义（P〉0.05）。联合组平均生存时间、3年生存率均高于单独组（χ~2=5.296,P=0.021;χ~2=3.913,P=0.048）,两组1年生存率、2年生存率、局部复发率与转移率差异无统计学意义（P〉0.05）。治疗后两组患者的炎性因子白细胞介素-6（IL-6）、IL-8、IL-12、IL-16和肿瘤坏死因子-α（TNF-α）均降低,联合组患者的炎症因子的改善程度均优于单独组（P〈0.05）。治疗后IgM和IgG含量升高,补体C3水平降低（P〈0.05）,联合组患者上述3项指标的改善幅度均优于单独组（P〈0.05）;两组患者IgA含量和补体C4水平治疗前后无明显变化（P〉0.05）。结论肝动脉化疗栓塞治疗乙型肝炎病毒相关性原发性肝细胞癌的同时给予恩替卡韦可提高近期和远期临床效果,降低炎症反应,增强机体免疫功能。

Objective To explore the clinical effects of the combination of transcatheter arterial chemoembolization and entecavir on hepatitis B virus associated primary hepatocellular carcinoma（HBV-HCC） and their influence on the inflammatory factors and immune function.Methods The total of 84 cases of HBVHCC were selected as the research objects,and divided into hepatic artery chemoembolization combined with entecavir treatment group（combined group） and single hepatic arterial chemoembolization group（single group）,42 cases in each group.The clinical effects,inflammatory factors and immune function were compared between the two groups.Results The clinical efficiency rate of combined group was significantly higher than that of single group（χ~2=10.868,P=0.001）.There was no significant difference in the disease control rate and adverse reaction rate between two groups（P〈0.05）.The mean survival time and the 3 years survival rate of the combined group were significantly higher than those of single group（χ~2=5.296,P=0.021;χ~2=3.913,P=0.048）,no significant differences were observed in the 1,2 year survival rate and local recurrence and metastasis rate between the two groups（P〈0.05）.After treatment,the inflammatory cytokines IL-6,IL-8 and IL-12,IL-16 and TNF-a were decreased in the two groups,and the improvements of cytokines in combined group were much better than single group（P〈0.05）.The levels of IgM and IgG were increased significantly after treatment,while complement C3 were decreased remarkably in both groups（P〈0.05）,the improvements of these indexes in the combined group were better than the single group（P〈0.05）,but no significant change was observed in the IgA and complement C4 before and after treatment（P〈0.05）.Conclusion Combination of transcatheter arterial chemoembolization and entecavir can significantly enhance the long-term and short-term clinical efficacy of hepatitis B virus associated primary hepatocellular carcinoma,reduce the level of inflammation and impove the immune function.