肝切除术后短期内乙型肝炎再活动的观察

Observation of hepatitis B reactivation within 1 month after partial hepatectomy

目的探讨乙型肝炎病毒(HBV)相关的肝细胞癌患者行肝切除术后短期(1个月)内乙型肝炎再活动的发生情况和危险因素。方法回顾性分析2015年1~12月期间在四川大学华西医院行部分肝切除术的HBV相关肝细胞癌患者的临床资料,并分析影响乙型肝炎再活动发生率的危险因素。结果 214例患者中有15例(7.0%)患者在术后短期内发生了乙型肝炎再活动。单因素分析结果显示,术前HBV-DNA阴性(P=0.023)及乙型肝炎e抗原阳性(P=0.001)与乙型肝炎再活动的发生有关,进一步进行多因素分析结果显示,术前HBV-DNA阴性[OR=9.21,95%置信区间为(2.40,35.45),P=0.001]及乙型肝炎e抗原阳性[OR=20.51,95%置信区间为(5.41,77.73),P<0.001]为部分肝切除术后乙型肝炎再活动的独立危险因素。结论 HBV相关肝细胞癌患者行部分肝切除术后短期内可能出现乙型肝炎再活动,尤其是对于术前HBV-DNA阴性及乙型肝炎e抗原阳性患者在术后短期内应加强HBV-DNA水平的监测,若一旦出现乙型肝炎再活动,应立即启动抗病毒治疗。

Objective To clarify incidence and risk factors of hepatitis B reactivation during short term （one month） in hepatitis B virus （HBV） related hepatocellular carcinoma （HCC） patients receiving partial hepatectomy. Methods From January 2015 to December 2015, 214 consecutive patients with HBV-related HCC who underwent partial hepatectomy were retrospectively enrolled in this study. The risk factors affecting incidence of hepatitis B reactivation were analyzed. Results Hepatitis B reactivation happened in 7.0% （15/214） of patients within 1 month after partial hepatectomy. By univariate analysis, the preoperative HBV-DNA negativity and hepatitis B e antigen （HBeAg） positivity were significantly correlated with the occurrence of hepatitis B reactivation （P=0.023 and P=0.001, respectively）. By multivariate analysis, the preoperative HBV-DNA negativity 〔OR=9.21, 95% CI （2.40, 35.45）, P=0.001〕 and HBeAg positivity 〔OR=20.51, 95% CI （5.41, 77.73）, P〈0.001〕 were the independent risk factors for hepatitis B reactivation. Conclusions Hepatitis B reactivation is common after partial hepatectomy for HBV-related HCC during short term, especially in patients whose preoperative HBV-DNA negativity and HBeAg positivity. A close monitoring of HBV-DNA during short term after partial hepatectomy is necessary, once hepatitis B is reactivated, antiviral therapy should be given.