肝动脉化疗栓塞术联合恩替卡韦对乙肝病毒脱氧核糖核酸阴性的乙型肝炎病毒相关性肝癌病人预后的影响

Impact of treatment of TACE combined with entecavir to prognosis of HBV-related hepatocellular carcinoma patients with undetectable HBV-DNA

目的探讨肝动脉化疗栓塞(TACE)联合恩替卡韦治疗乙肝病毒脱氧核糖核酸(HBV-DNA)阴性的乙型肝炎病毒(HBV)相关性肝癌病例的疗效和预后。方法选择HBV-DNA阴性的HBV相关性肝癌病人112例,按随机数字表法分为观察组和对照组,每组56例。观察组采用TACE联合恩替卡韦治疗,对照组仅行TACE治疗。检测并比较两组病人术前1周、术后1周及2周的肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、γ-谷氨酰转肽酶(GGT)]、血清HBV-DNA,随访并比较治疗的有效率和生存情况。结果两组TACE术后1周均出现肝功能损害(ALT、AST、TBil和GGT升高),观察组ALT、AST和TBil均低于对照组(P<0.05)。术后2周两组ALT、AST、TBil和GGT均有下降,且观察组ALT、AST、TBil和GGT均低于对照组(P<0.05)。术后3个月观察组治疗有效率为35.72%,高于对照组的16.04%(P<0.05)。术后6个月生存率差异无统计学意义(P>0.05)。观察组和对照组术后12个月生存率分别为82.14%和58.93%(P<0.05),观察组HBV激活率为5.36%,低于对照组的14.29%(P<0.05)。结论对HBV-DNA阴性的HBV相关性肝癌病例采用TACE术联合恩替卡韦治疗,能改善TACE导致的肝功能损害,降低HBV的激活率,延长1年生存期。

Objective To evaluate efficacy and prognosis of treatment of transcatheter arterial chemoembolization （TACE） combined with Entecavir to prognosis of HBV-related hepatocellular carcinoma patients with undetectable HBV-DNA. Methods A total of 112 HBV-related hepatocellular carcinoma patients with undetectable HBV-DNA were chosen and randomly divided into observation （56 ca-ses） group and controls （56 cases） . The liver function （ ALT, AST,TBil,GGT） and HBV-DNA 1 week before TACE,1 and 2 weeks af-ter TACE were tested and compared. The effective rate and survival rate of patients were followed up. Results Liver function impair-ment occurred in 2 groups 1 week after TACE. The level of ALT,AST and TBil in observation group were lower than those of controls （P 〈 0. 05 ） . The level of ALT, AST, TBil and GGT all declined 2 weeks after TACE, and ALT, AST, TBil and GGT in observation group were all lower than those of controls （P 〈0. 05）. The effective rate of observation group （35. 72% ） was higher than that of controls （16. 04% ） 3 months after TACE （ P 〈 0. 05 ） . There was no significant difference in survival rate between 6 months after operation. The survival rate of observation group （82. 14% ） was higher than that of controls （58.93% ） 12 months after TACE （P 〈 0 .0 5 ） ,and the reactivation rate of HBV-DNA of observation group （5. 36% ） was lower than that of controls （ 14. 29% ） （P 〈 0. 05 ） . Conclusion Using the combination of TACE with Entecavir to treat HBV-related hepatocellular carcinoma patients with negative HBV-DNA can im-prove the liver function impairment caused by TACE,reduce the reactivation rate of HBV and prolonged the survival of 1 year.