恩替卡韦抗病毒治疗对HBV相关HCC根治性消融治疗术后临床转归的影响

发布时间：2018-07-13 14:02

【摘要】：目的:探讨恩替卡韦抗病毒治疗对乙型肝炎病毒相关肝细胞癌根治性消融治疗术后临床转归的影响。方法:回顾性研究天津市第二人民医院自2011年1月至2014年2月期间收治的103例乙型肝炎病毒相关肝细胞癌患者,将患者按照抗病毒治疗药物不同分成2组,即根治性消融治疗联合拉米夫定抗病毒治疗组(n=50)和根治性消融治疗联合恩替卡韦抗病毒治疗组(n=53),消融治疗后应用抗病毒治疗随访3年,观察其治疗前及治疗期间ALT、AST、GGT、ALB、TBIL、BUN、CRE、PLT、PT、HBsAg、HBe Ag、高敏HBV-DNA、AFP的变化,观察其肿瘤新生/复发的情况,随访患者治疗期间并发症发生情况,随访患者生存期,以评估恩替卡韦抗病毒治疗对于乙型肝炎病毒相关肝细胞癌患者生存期及生存质量的临床转归及影响。结果:1.两组患者治疗前在ALT、AST、GGT、ALB、TBIL、BUN、CRE、PLT、PT、HBs Ag、HBeAg、高敏HBV-DNA、AFP、BCLC分期及肿瘤分化程度上均无显著差异(P0.05)。2.对两组患者在治疗前、治疗1个月、3个月、6个月、1年、2年及3年ALT、AST、GGT、ALB、TBIL、BUN、CRE、PLT、PT、HBsAg、HBeAg分别进行比较,各项指标均无显著性差异(P0.05)。3.分析两组各时间段高敏HBV-DNA水平情况,两组于抗病毒治疗1月、3月及6月高敏HBV-DNA水平,经统计学处理无意义(P0.05),治疗1年、2年及3年两组高敏HBV-DNA水平,经统计学处理有意义(P=0.016,P=0.06,P=0.012)。4.对两组患者在治疗前、治疗1个月、3个月、6个月、1年、2年及3年期间肝功能Child-Pugh评分进行比较,结果显示两组患者治疗前、治疗1个月、3个月、6个月期间肝功能Child-Pugh评分比较无显著性差异(P0.05),在抗病毒治疗1年以后,两组患者Child-Pugh评分比较均有显著性差异(P=0.03,P=0.011,P=0.021)。5.对两组患者在治疗1个月、3个月、6个月、1年、2年及3年期间肿瘤新生/复发情况进行比较,两组患者抗病毒治疗1个月、3个月、6个月期间肿瘤新生/复发情况比较无显著性差异(P0.05),抗病毒治疗1年、2年及3年,两组患者肿瘤新生/复发情况比较,均有显著性差异(P=0.024,P=0.038,P=0.019)。6.随访两组患者治疗期间并发症发生情况,两组患者在上消化道出血及肝癌结节破裂出血并发症发生情况比较,有显著性差异(P0.05)。而在其他并发症发生情况比较,无显著性差异(P0.05)。7.随访两组患者生存期,两组患者抗病毒治疗6个月、1年、2年生存率比较,无显著性差异(P0.05),抗病毒治疗3年患者生存率比较,有显著性差异(P0.05)。结论:对于乙型肝炎病毒相关肝细胞癌根治性消融治疗术后患者,恩替卡韦抗病毒治疗可将HBV复制抑制至较低水平,改善肝脏功能,减少终末期肝病事件的发生,提高生命质量,降低肿瘤新生/复发风险,获得更高的生存率。
[Abstract]:Objective: to investigate the effect of entecavir antiviral therapy on the clinical outcome after radical ablation of hepatitis B virus associated hepatocellular carcinoma. Methods: 103 patients with hepatitis B virus associated hepatocellular carcinoma treated in Tianjin second people's Hospital from January 2011 to February 2014 were retrospectively studied. The patients were divided into two groups according to antiviral drugs. That is, radical ablation therapy combined with lamivudine antiviral therapy group (NN50) and radical ablation therapy combined with entecavir antiviral therapy group (NN53). The patients were followed up for 3 years with antiviral therapy after ablation. To observe the changes of HBe and Gao Min HBV-DNA Gao Min before and during the treatment, to observe the occurrence of complications during the follow-up, and to observe the survival time of the patients, and to observe the changes of HBe and HBV-DNA AFP before and during the treatment. To evaluate the clinical outcome and effect of entecavir antiviral therapy on survival and quality of life of patients with hepatitis B virus associated hepatocellular carcinoma. The result is 1: 1. Before treatment, there was no significant difference between the two groups in the levels of HBeAg, Gao Min HBV-DNA, AFP-BCLC staging and tumor differentiation (P0.05). Before treatment, the patients in the two groups were treated for 1 month, 3 months, 6 months, 1 year, 2 years and 3 years, respectively. There was no significant difference in all the indexes between the two groups (P0.05). The levels of Gao Min HBV-DNA in the two groups were analyzed in each time period. The levels of Gao Min HBV-DNA in the two groups were not statistically significant at 1 month, 3 months and 6 months after antiviral treatment (P0.05). The levels of Gao Min HBV-DNA in the two groups were statistically significant (P0.016, P0.06, P0.012) .4.The level of HBV-DNA in the two groups was significantly higher than that in the control group (P 0.016, P 0.06, P 0.012). Child-Pugh scores of liver function were compared between the two groups before treatment for 1 month, 3 months, 6 months, 1 year, 2 years and 3 years. There was no significant difference in Child-Pugh score between the two groups after 1 month, 3 months and 6 months of treatment (P0.05). After one year of antiviral therapy, there was significant difference in Child-Pugh score between the two groups (P < 0.05). A comparison was made between the two groups of tumor regeneration / recurrence during 1 month, 3 months, 6 months, 1 year, 2 years and 3 years of treatment. There was no significant difference in tumor regeneration / recurrence between the two groups during antiviral therapy for 1 month, 3 months and 6 months (P0.05), but there was significant difference between the two groups (P0.024, P0. 038, P0. 019) .6in antiviral therapy for 1 year, 2 years and 3 years, there was a significant difference between the two groups (P0. 024, P0. 038, P0. 019). Follow up the two groups of patients during the treatment of complications, the two groups in the upper gastrointestinal bleeding and liver cancer nodules rupture bleeding complications, there was significant difference (P0.05). However, there was no significant difference in the occurrence of other complications (P0.05). There was no significant difference in survival rate between the two groups after 6 months, 1 year and 2 years of antiviral therapy (P0.05), but there was a significant difference in the 3-year survival rate of the patients treated with antiviral therapy (P0.05). Conclusion: for patients with hepatitis B virus associated hepatocellular carcinoma after radical ablation therapy, entecavir antiviral therapy can inhibit HBV replication to a lower level, improve liver function and reduce the incidence of end-stage liver disease. Improve the quality of life, reduce the risk of tumor growth / recurrence, and achieve a higher survival rate.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

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