TACE序贯二期RFA联合NA治疗Ⅰ期结节型HBV相关性肝癌的疗效及对血清学指标和HBV DNA的影响

TACE sequential Ⅱ phase RFA combined with NA antiviral treatment of stage Ⅰ nodular HBV associated liver cancer and the impact on serological indicators and HBV DNA

目的探讨经导管动脉栓塞化疗(TACE)序贯二期射频消融(RFA)联合核苷(酸)类似物(NA)治疗Ⅰ期结节型HBV相关性肝癌的疗效及对血清学指标和HBV DNA的影响。方法选择87例Ⅰ期结节型HBV相关性肝癌患者,依据随机数字表法将患者分为对照组(n=43)和观察组(n=44),对照组患者接受TACE序贯二期RFA治疗,观察组患者接受TACE序贯二期RFA结合NA抗病毒治疗。分别于治疗前及治疗后1、3、6个月检测两组患者的丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、甲胎蛋白(AFP)和糖类抗原19-9(CA19-9)水平及HBV DNA的不可测率,并比较两组患者的治疗有效率。结果治疗后1、3、6个月,观察组患者的的血清ALT和AST水平与治疗前比较,差异均无统计学意义(P﹥0.05);治疗后3个月和治疗后6个月,对照组患者的血清ALT和AST水平均高于本组治疗前及同时间点观察组患者,差异均有统计学意义(P﹤0.05)。治疗后1、3、6个月,对照组患者的的血清AFP和CA19-9水平与治疗前比较,差异均无统计学意义(P﹥0.05);治疗后3个月和治疗后6个月,观察组患者的血清AFP和CA19-9水平均低于本组治疗前及同时间点对照组患者,差异均有统计学意义(P﹤0.05)。治疗后3个月和治疗后6个月观察组患者的HBV DNA不可测率均高于对照组(P﹤0.05)。治疗后6个月,观察组患者的有效率为86.36%(38/44),高于对照组的65.12%(28/43),差异有统计学意义(P﹤0.05)。结论TACE序贯二期RFA联合NA抗病毒治疗Ⅰ期结节型HBV相关性肝癌可改善患者的血清ALT、AST水平,降低血清AFP、CA19-9水平,提高HBV DNA不可测率,为治疗HBV相关性肝癌提供保障。

Objective To study the efficacy of transcatheter arterial chemoembolization （TACE） sequential Ⅱ phase radiofrequency ablation （RFA） combined with nucleotide analog （NA） in the treatment of stage Ⅰ nodular HBV associated liver cancer and the impact on serological indicators and HBV DNA. Method Eighty-seven patients with stage Ⅰ nodular HBV associated liver cancer were randomly divided into control group （43 cases） and observation group （44 cases）, the control group received sequential TACE with Ⅱ phase RFA treatment, the observation group received sequential TACE with Ⅱ phase RFA combined with NA antiviral therapy, respectively. Before the tzeatment and at 1, 3 and 6 months after treatment, the level of alanine aminotransferase （ALT）, aspartic aminotransferase （AST）, alpha fetal protein （AFP）, CA 19- 9, and undetectable rate of HBV DNA were all measured. The response rates of treatments of two groups were compared. Result In observe group, there was no significant difference in the levels of serum ALT and AST between before and after treatment （P〉0.05）, while the ALT and AST levels of control group at 3 and 6 months after treatment were significant- ly higher than those before treatment （P〈0.05）, and also significantly＇ higher than those of observation group at the same time after treatment （P〈0.05）. There was no significant difference in the serum levels of CA19-9 and AFP of control group between before treatment and 1, 3 and 6 months after treatment （P〉0.05）. At 3 and 6 months after treatment, the serum levels of CA 19-9 and AFP of observation group were significantly lower than those before treatment （P〈0.05）, and also significantly lower than those of control group at the same time after treatment （P〈0.05）. At 3 and 6 months after treatment, HBV DNA undetectable rates of observation group were significantly higher than those of the control group （P〈0.05）. At 6 months after treatment, the response rate of observation group was 86.36% （38/44）, which was significantly higher than that of control group as 65.12% （28/43, P〈0.05）.Conclusion TACE sequential with Ⅱ phase RFA combined with NA as the treatment of stage Ⅰ nodular HBV associated liver cancer can improve the level of ALT and AST, decrease the level of AFP and CA 19-9, increase the undetectable rate of HBV DNA, and provide guarantee for the treatment of HBV associated liver cancer.