术前HBV-DNA载量对肝细胞癌术后肝功能衰竭的影响

Effect of preoperative HBV-DNA load on risk of liver failure after hepatectomy in patients with hepatocellular carcinoma

目的探讨术前HBV—DNA载量对肝细胞癌（hepatocellularcarcinoma，HCC）术后肝功能衰竭（posthepatectomyliverfailure，PHLF）的影响。方法回顾性分析342例术前肝功能Child—PughA级HCC患者行肝切除术的临床资料，根据术前HBV—DNA不同载量进行分组，比较术前HBV—DNA载量与PHLF发生的关系。结果术后发生PHLF99例（29．O％oPHLF总发生率≥1061U／mL组为42．6％（20／47）、105IU／mL组为29．2％（21H2）、104IU／mL组为34．9％（22／63）、103IU／mL组为19．7％（11／56）、〈103IU／mL组为24．0％（25／104），差异无统计学意义（x2=8．900，P=0．064）；PHLF—B级及以上的发生率分别为21-3％（10／47）、16．7％（12／72）、19．0％（12／63）、10．7％（6／56）、13．5％（14／104），差异亦无统计学意义（x2=3．118，P=O．538）。根据术前HBV—DNA不同载量进一步行亚组分析PHLF—B级及以上发生率，各亚组间比较差异均无统计学意义（P〉0．05）.结论 术前HBV—DNA载量对PHLF-B级及以上发生无明显影响，对于肝功能Child—PughA级患者，术前经简单抗病毒治疗后应尽快手术。

Objective The purpose of this study was to explore the impact of preoperative HBV-DNA levels on posthepatectomy liver failure （PHLF）. Methods This prospective cohort study included 342 consecutive Child-Pugh A hepatocellular carcinoma patients who underwent partial hepatectomy. Possible correlations were explored between preoperative HBV-DNA load and PHLF. Results Of the 342 patients, 99 （29.0%） developed PHLF. Incidence of PHLF by preoperative HBV-DNA load was as follows： 〉 106 IU/mL, 42.6% （ 20/47 ） ; 105 IU/mL, 29.2% （ 21/72 ） ; l04 IU/mL, 34.9% （ 22/63 ） ; l03 IU/mL, 19.7% （ 11/56 ） ; and 〈103 1U/mL, 24.0%（25/104）. The association between PHLF and HBV-DNA load was not significant （X2=8.900, P=0.064 ）. Similarly,the association between incidence of PHLF-B and HBV-DNA load was not slgnificant（x2=3.118 ,P=0.538 ）：〉106 IU/mL, 21.3%（ 10/47 ）; l05 IU/mL, 16.7% （ 12/72 ） ; 104 IU/mL, 19.0% （ 12/63 ）; 103 IU/mL, 10.7% （6/56） ;and 〈lO3 IU/mL, 13.5% （ 14/104 ）. Conclusions Preoperative HBV-DNA load level does not appear to be related to the incidence of PHLF at Child-Pugh ]evel B or above. This suggests that simple antiviral treatment can be started as soon as possible after surgery in hepatocellular carcinoma patients with Child-Pugh A liver function.