乙肝免疫球蛋白预防乙肝相关肝癌患者术后病毒再激活的效果研究

Efficacy of hepatitis B immunoglobulin in preventing postoperative virus reactivation in patients with HBV-related liver cancer

目的前瞻性评估乙肝免疫球蛋白(HBIg)预防乙肝相关肝癌患者术后HBV再激活的效果。方法纳入2014年6月至10月在复旦大学附属中山医院诊断为原发性肝癌且血清乙肝表面抗原(HBsAg)阳性的患者51例,按照治疗方法不同分为2组,其中治疗组38例,为血清HBV-DNA阳性患者,术前予以HBIg治疗;对照组13例,为血清HBV-DNA阴性患者。分析比较两组患者术后病毒激活率和HBIg有效率。结果HBIg治疗组术后病毒激活率明显低于对照组(7.9%vs 53.8%,P=0.001)。Logistic回归分析表明,未予HBIg治疗是术后病毒激活的独立危险因素(OR 64.167,95%CI 9.472~434.696,P<0.001)。治疗组中合并谷丙转氨酶(ALT)异常的患者术后病毒激活率高于ALT正常者,但无统计学差异(15.4%vs 4.0%,P=0.55)。治疗组中HBIg总体有效率为34.2%,其中合并ALT异常者有效率高于ALT正常者(61.5%vs 20.0%,P=0.011)。另外,长期使用核苷类似物(NAs)的患者术后病毒激活率与未使用者无统计学差异(P>0.05)。结论HBIg可有效预防乙肝相关肝癌患者术后HBV再激活,且在伴有ALT水平异常的患者中治疗效果更好。

Objective To evaluate the effect of hepatitis B immunoglobulin(HBIg)on preventing postoperative HBV reactivation in patients with HBV-related liver cancer prospectively.Methods A total of 51 patients with diagnosis of primary liver cancer and positive hepatitis B surface antigen(HBsAg)in Zhongshan Hospital,Fudan University from Jun.to Oct.2014 were enrolled.38 patients with positive HBV-DNA were included in the treatment group and received HBIg before operation,while other 13 patients with negative HBV-DNA were assigned into the control group.The postoperative HBV reactivation rate and HBIg efficacy of the two groups were compared.Results The postoperative HBV reactivation rate in the treatment group was significantly lower than that in the control group(7.9%vs 53.8%,P=0.001).Logistic analysis showed that without HBIg treatment was an independent risk factor for postoperative viral activation(OR 64.167,95%CI 9.472~434.696,P<0.001).Patients in the treatment group with abnormal alanine aminotransferase(ALT)level experienced higher virus activation rate than those with normal ALT,but the difference had no statistical significance(15.4%vs 4.0%,P=0.55).The overall HBIg efficacy in the treatment group was 34.2%.Patients with abnormal ALT level had better HBIg efficacy compared with those with normal ALT level(61.5%vs 20.0%,P=0.011).Additionally,patients using long-term nucleotide analogs(NAs)showed no statistical difference in HBV reactivation rate compared with those who not using NAs(P>0.05).Conclusion HBIg can effectively prevent postoperative HBV reactivation in patients with HBV-related liver cancer.The efficacy of HBIg may be better in patients with abnormal ALT level.