乙型肝炎相关性原发性肝癌术后患者对核苷（酸）类似物耐药及预存耐药后相关预后分析及对临床决策的影响
[Abstract]:Objective to analyze the prognostic factors of nucleoside analogue (NAS) resistance in patients with hepatitis B virus (HBV) associated primary liver cancer (HCC) after operation, and to compare the clinical characteristics and survival time between patients with NAS insensitivity and those who did not take NAS at the same time. To detect the presence of pre-drug resistance in such patients, and therefore to explore clinicians' decision-making for antiviral therapy. Methods from January 2011 to July 2014, 482 patients with HBV-associated HCC received radical resection in our hospital from January 2011 to July 2014. None of these patients were treated with NAS antiviral therapy before operation. The patient's history, serological, imaging and pathological data were collected, and the same patient's serum was collected for the detection of hepatitis B virus genotypes and two drug resistance mutation sites before and after medication. The patients were divided into two groups according to the drug use and the results of the drug resistance locus test: the NAS resistant group was not resistant to NAS and the NAS group was not used after the operation. The statistical software SPSS 21.0 was used to carry out the T-test including chi-square test, the rank sum test was used to compare the data difference, and the cumulative survival function curve was used to analyze the survival. Results the level of transaminase and the Child-Pugh score of HBs Ag titer were significantly better than those without NAS therapy (P0.05) and NAS-resistant patients (P0.05) in the patients who received NAS antiviral therapy, and the patients who were resistant to NAS were significantly better than those who were not treated with NAS (P0.05), and those who were resistant to NAS (P0.05) were significantly better than those who were not treated with NAS (P0.05) and those who were resistant to NAS. The above indexes of patients who developed drug resistance after NAS use were significantly lower than those without NAS therapy (P0.05). 84.6% of the patients with preexisting drug resistance had poor prognosis due to improper selection of NAS (P0. 05). Conclusion the survival rate of NAS-resistant HCC patients was significantly lower than that of NAS-resistant patients and non-NAS resistant HCC patients. Therefore, in order to improve the prognosis of patients with HBV-associated HCC, it is important to select effective, low drug resistant antiviral drugs. And it may be necessary to test for pre-drug resistance before medication.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R735.7
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