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恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术预后的影响

何伟猛 张植明 侯金林 何雅婧

何伟猛, 张植明, 侯金林, 等. 恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术预后的影响[J]. 临床肝胆病杂志, 2021, 37(3): 601-605. DOI: 10.3969/j.issn.1001-5256.2021.03.019
引用本文: 何伟猛, 张植明, 侯金林, 等. 恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术预后的影响[J]. 临床肝胆病杂志, 2021, 37(3): 601-605. DOI: 10.3969/j.issn.1001-5256.2021.03.019
HE WM, ZHANG Z, HOU JL, et al. Effect of entecavir antiviral therapy on the prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after transcatheter arterial chemoembolization [J]. J Clin Hepatol, 2021, 37(3): 601-605. DOI: 10.3969/j.issn.1001-5256.2021.03.019
Citation: HE WM, ZHANG Z, HOU JL, et al. Effect of entecavir antiviral therapy on the prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after transcatheter arterial chemoembolization [J]. J Clin Hepatol, 2021, 37(3): 601-605. DOI: 10.3969/j.issn.1001-5256.2021.03.019

恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术预后的影响

DOI: 10.3969/j.issn.1001-5256.2021.03.019
基金项目: 

广东省自然科学基金 1914050005908

广东省医学科学技术研究基金 A2019480

深圳市三名工程项目资助 SZSM201911001

详细信息
    作者简介:

    何伟猛(1994—),男,主要从事肝脏疾病相关的基础与临床研究

    通讯作者:

    侯金林,jlhousmu@163.com

    何雅婧,heyajing529@126.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:何伟猛、何雅婧负责课题设计,资料分析,撰写论文;张植明参与收集数据,修改论文;何伟猛、侯金林负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R735.7

Effect of entecavir antiviral therapy on the prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after transcatheter arterial chemoembolization

  • 摘要:   目的  探讨恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术(TACE)预后的影响。  方法  选取2011年1月—2018年3月在南方医院肝肿瘤中心首次接受TACE治疗的HCC患者170例,包括恩替卡韦治疗组114例,对照组(未抗病毒治疗)56例。记录治疗前基线的人口学资料,ALT、AST、TBil、Alb、PLT和Child-Pugh分级,HBeAg和HBV DNA水平,AFP、BCLC分期,以及治疗后4~8周的HBV DNA水平,ALT、AST、TBil、Alb和Child-Pugh分级变化和治疗后长期的生存状况。观察患者的短期和长期临床获益(总生存期)。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。对治疗前临床相关指标进行多因素logistic分析,以发现与乙型肝炎再活动的相关危险因素。Kaplan-Meier法分析总生存期的生存曲线,log-rank检验生存曲线间差异性。  结果  恩替卡韦治疗组患者乙型肝炎再活动的发生率与对照组比较无差异(15.79% vs 16.07%,χ2=0.002, P=0.962)。PLT水平在乙型肝炎再活动组与无乙型肝炎再活动组间差异有统计学意义(Z=-2.183, P=0.029)。多因素分析结果显示,HBV DNA水平是乙型肝炎再活动的独立危险因素(HR=1.000,P=0.015)。恩替卡韦组的1、3和5年生存率分别是56.20%、30.30%和13.20%,对照组的1、3和5年生存率分别是60.60%、27.20%和16.30%,两组在总体生存率上差异无统计学意义(χ2= 0.049,P=0.755)。  结论  抗病毒治疗可以抑制乙型肝炎相关HCC患者TACE术后HBV复制,从而减少TACE治疗的肝毒性。
  • 图  1  两组患者OS的生存曲线

    表  1  恩替卡韦组和对照组的基线特征比较

    指标 恩替卡韦组(n=114) 对照组(n=56) 统计值 P
    男/女(例) 102/12 49/7 χ2=0.147 0.701
    年龄(岁) 50.93±10.95 50.45±12.50 t=-0.247 0.806
    ALT(U/L) 47.00(30.75~64.93) 41.00(26.25~56.00) Z=-1.658 0.097
    AST(U/L) 58.70(40.80~94.08) 50.50(31.25~72.25) Z=-1.933 0.053
    TBil(μmol/L) 16.25(11.80~21.80) 15.15(10.08~21.40) Z=-0.922 0.357
    Alb(g/L) 36.41±5.58 36.86±5.20 t=0.522 0.603
    PT(s) 13.68±1.78 13.46±1.53 t=-0.835 0.405
    PLT(×109/L) 153.50(112.75~164.00) 158.50(103.25~217.50) Z=-0.090 0.929
    AFP(<400 ng/ml/≥400 ng/ml, 例) 64/50 36/20 χ2=1.029 0.310
    肿瘤直径(cm) 5.50(2.73~9.45) 6.50(3.20~10.45) Z=-1.078 0.281
    肿瘤数目(1/2/≥3, 例) 57/7/50 20/5/31 χ2=3.147 0.207
    HBV DNA(<105拷贝/ml/≥105拷贝/ml, 例) 52/62 36/20 χ2=5.243 0.022
    HBeAg(阴性/阳性, 例) 87/27 39/17 χ2=0.872 0.350
    Child-Pugh分级(A/B, 例) 85/29 40/16 χ2=0.189 0.663
    有无门脉癌栓(有/无, 例) 69/45 42/14 χ2=3.472 0.062
    BCLC分期(0/A/B/C/D, 例) 9/35/24/33/13 5/17/17/9/8 χ2=4.171 0.383
    下载: 导出CSV

    表  2  乙型肝炎再活动的单因素分析

    指标 乙型肝炎再活动(n=27) 无乙型肝炎再活动(n=143) 统计值 P
    男/女(例) 23/4 128/15 χ2=0.428 0.513
    年龄(岁) 49.19±10.35 51.07±11.65 t=0.784 0.434
    ALT(U/L) 45.00(30.50~60.80) 44.00(28.00~61.10) Z=-0.303 0.762
    AST(U/L) 60.00(43.00~115.00) 53.00(37.00~86.50) Z=-0.981 0.327
    TBil(μmol/L) 17.80(12.20~24.50) 15.10(11.35~21.40) Z=-1.328 0.184
    Alb(g/L) 36.15±5.36 36.64±5.48 t=0.422 0.674
    PT(s) 13.73±1.65 13.58±1.72 t=-0.428 0.670
    PLT(×109/L) 155.00(118.50~210.50) 155.00(106.00~222.00) Z=-2.183 0.029
    AFP(<400/≥400 ng/ml, 例) 16/11 85/58 χ2=0.000 0.986
    肿瘤直径(cm) 6.80(2.90~11.50) 5.90(3.00~9.45) Z=-1.759 0.079
    肿瘤数目(1/2/≥3,个) 11/0/16 66/12/65 χ2=3.321 0.190
    HBV DNA(<105拷贝/ml/≥105拷贝/ml,例) 14/13 74/69 χ2=0.000 0.992
    HBeAg(阴性/阳性, 例) 19/8 107/36 χ2=0.235 0.628
    Child-Pugh(A/B,例) 19/8 106/37 χ2=0.165 0.685
    有无门脉癌栓(有/无,例) 11/16 51/92 χ2=0.253 0.615
    BCLC分期(0/A/B/C/D,例) 1/6/10/6/4 8/46/33/37/19 χ2=2.797 0.592
    抗病毒治疗(是/否, 例) 18/9 96/47 χ2=0.002 0.962
    下载: 导出CSV

    表  3  乙型肝炎再活动的多因素分析

    指标 B SE Wald HR 95%CI P
    PLT 0.002 0.003 0.812 0.998 0.993~1.003 0.368
    肿瘤直径 0.077 0.009 2.431 1.080 0.980~1.189 0.119
    抗病毒治疗 0.305 0.455 0.449 1.356 0.556~3.308 0.503
    HBV DNA 0.000 0.000 5.915 1.000 1.000~1.000 0.015
    HBeAg 0.866 0.480 3.255 0.421 0.164~1.078 0.071
    下载: 导出CSV
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  • 收稿日期:  2020-09-14
  • 修回日期:  2020-09-29
  • 刊出日期:  2021-03-16
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