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经肝动脉化疗栓塞术后参芪肝康片联合抗病毒治疗HBV相关肝细胞癌的效果观察
Clinical effect of Shenqi Gankang tablets combined with antiviral therapy after transcatheter arterial chemoembolization in treatment of hepatitis B virus-related hepatocellular carcinoma
文章发布日期:2018年09月30日  来源:  作者:魏帅,杨道坤,高海丽,等  点击次数:329次  下载次数:25次

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【摘要】:目的探讨经肝动脉化疗栓塞术(TACE)后参芪肝康片联合抗病毒治疗HBV相关肝细胞癌的临床效果。方法选取2015年10月-2017年2月新乡医学院第一附属医院收治的HBV相关肝细胞癌患者106例,随机分为对照组(TACE+恩替卡韦组)57例、试验组(参芪肝康片+TACE+恩替卡韦组)49例,最终完成随访89例(对照组44例、试验组45例)。观察治疗前和治疗1、3、6、12个月后患者TBil、ALT、AFP、Alb水平变化,记录治疗前及治疗12个月后患者CD3+、CD4+、CD8+ T淋巴细胞水平、生存率、Child-Pugh分级和卡氏(KPS)评分变化。计数资料组间比较采用χ2检验或Wilcoxon秩和检验。符合正态分布的计量资料2组间比较采用t检验;非正态分布计量资料2组间比较采用Wilcoxon秩和检验。结果治疗3个月后,试验组ALT、TBil、Alb水平较对照组好转,差异均有统计学意义(P值均<0.05);治疗6、12个月后,试验组ATL、TBil、AFP、Alb水平较对照组进一步好转,差异均有统计学意义(P值均<0.05)。试验组ALT、AFP、TBil、Alb水平变化趋势优于对照组,且ALT、TBil、Alb相较于对照组呈持续好转趋势。治疗12个月后,试验组CD4+、CD4+/CD8+ T淋巴细胞百分比高于对照组,CD8+T淋巴细胞百分比低于对照组,差异均有统计学意义(t值分别为-2.202、3.851、-5.324,P值分别为0.030、<0001、<0001)。随访第12个月,对照组生存44例,死亡9例,生存率83.0%;试验组生存45例,死亡2例,生存率95.7%,2组生存率差异有统计学意义(χ2=4.121,P=0.042);试验组患者Child-Pugh分级较对照组改善,差异有统计学意义(Z=-2.260,P=0.024);试验组患者KPS评分明显改善和改善例数分别为11、25例,占80.00%;对照组分别为5、19例,占5455%,2组改善率比较差异有统计学意义(Z=-2.688,P=0.007)。结论参芪肝康片联合TACE术后抗病毒治疗HBV相关肝细胞癌,在调节免疫系统、改善肝功能、降低胆红素水平、提高生存率等方面优于单纯TACE术后抗病毒治疗。
【Abstract】:ObjectiveTo investigate the clinical effect of Shenqi Gankang tablets combined with antiviral therapy after transcatheter arterial chemoembolization (TACE) in the treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). MethodsA total of 106 patients with HBV-related HCC who were admitted to The First Affiliated Hospital of Xinxiang Medical University from October 2015 to February 2017 were enrolled and randomly divided into control group with 57 patients (treated with TACE+entecavir) and experimental group with 49 patients (treated with Shenqi Gankang tablets+TACE+entecavir). Among these patients, 89 completed follow-up (44 in the control group and 45 in the experimental group). The levels of total bilirubin (TBil), alanine aminotransferase (ALT), alpha-fetoprotein (AFP), and albumin (Alb) were measured before treatment and after 1, 3, 6, and 12 months of treatment; the percentages of CD3+, CD4+, and CD8+ T lymphocytes, Child-Pugh class, and Karnofsky Performance Scale (KPS) score were recorded before treatment and after 12 months of treatment, and survival rate was calculated after 12 months of treatment. The chi-square test or Wilcoxon rank sum test was used for comparison of sex and genotype and allele frequencies between the two groups. The independent samples t-test and Wilcoxon rank sum test were used for comparison of continuous data between the two groups. ResultsAfter 3 months of treatment, the experimental group had significant improvements in the levels of ALT, TBil, and Alb than the control group (all P<0.05); after 6 and 12 months of treatment, the experimental groups had further improvements in these indices than the control group (all P<0.05). Compared with the control group, the experimental group had a better change trend of ALT, AFP, TBil, and Alb and continuous improvements in ALT, TBil, and Alb. After 12 months of treatment, compared with the control group, the experimental group had a significantly higher percentage of CD4+ T lymphocytes, a significantly higher CD4+/CD8+ ratio, and a significantly lower percentage of CD8+ T lymphocytes (t=-2.202, 3.851, and -5.324, P=0.030, <0001, and <0001). At month 12 of follow-up, in the control group, 44 patients survived and 9 died, resulting in a survival rate of 83.0%; in the experimental group, 45 survived and 2 died, resulting in a survival rate of 95.7%; there was a significant difference in survival rate between the two groups (χ2=4.121, P=0.042). The experimental group had a significant improvement in Child-Pugh class than the control group, and there was a significant difference in Child-Pugh class between the two groups (Z=-2.260, P=0.024). In the experimental group, 11 patients achieved a significant improvement in KPS score and 25 achieved a certain improvement, resulting in an improvement rate of 80.00%; in the control group, 5 patients achieved a significant improvement in KPS score and 19 achieved a certain improvement, resulting in an improvement rate of 54.55%; there was a significant difference in improvement rate between the two groups (Z=-2.688, P=0.007). ConclusionCompared with antiviral therapy after TACE in the treatment of HBV-related HCC, Shenqi Gankang tablets combined with antiviral therapy after TACE has a better clinical effect in regulating the immune system, improving liver function, reducing bilirubin level, and improving survival rate.
【关键字】:癌, 肝细胞 ; 肝炎病毒, 乙型; 化学栓塞, 治疗性; 参芪肝康片
【Key words】:carcinoma, hepatocellular; hepatitis B virus; chemoembolization, therapeutic; Shenqi Gankang
【引证本文】:YANG DK, WEI S, GAO HL, et al. Clinical effect of Shenqi Gankang tablets combined with antiviral therapy after transcatheter arterial chemoembolization in treatment of hepatitis B virus-related hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34(11): 2345-2351. (in Chinese) 杨道坤, 魏帅, 高海丽, 等. 经肝动脉化疗栓塞术后参芪肝康片联合抗病毒治疗HBV相关肝细胞癌的效果观察[J]. 临床肝胆病杂志, 2018, 34(11): 2345-2351.

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