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Treatment of liver cirrhosis with postoperative hepatocellular carcinoma with nucleoside analog
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摘要: 目的评价核苷类抗病毒治疗伴活动性肝硬化肝癌（HCC）术后的临床疗效。方法 45例伴活动性肝硬化HCC术后患者随机分治疗组与对照组。22例对照组采用单纯手术切除或肝动脉化疗栓塞术（TACE）介入,治疗组23例,采用手术切除或TACE术后核苷类抗病毒治疗。其中:①拉米夫定（LAM）组7例,100 mg/d,口服;②恩替卡韦（ETV）组16例,0.5 mg/d,口服;疗程1年以上,两组保肝基础治疗无差异。结果治疗48周和96周时结果提示,接受ETV治疗后血清HBVDNA水平基线的平均降幅及应答率均大于LAM治疗者,LAM组和ETV组在治疗48周时HBVDNA阴转率分别为71.4%与81.2%,显著高于对照组P<0.05。肝功能和Child-Pugh计分改善优于对照组。治疗组48周和96周累计生存率分别为78.2%与60.8%,而对照组分别是50.0%与36.3%,两组差异有统计学意义（P<0.05）。结论 LAM、ETV抗病毒治疗伴活动性肝硬化HCC能快速、强效地抑制乙肝病毒复制,最大限度的延缓复发,提高患者的生存质量。Abstract: Objective To evaluate the therapeutic efficacy of nucleoside analogs anti-viral treatment for liver cirrhosis with postoperative hepatocellular carcinoma (HCC) .Methods 45 HCC cases with active liver cirrhosis were divided into treatment group and control group.22 cases under the control group had a hepatic transcatheter arterial chemoembolization (TACE) surgery and the 23 cases in the treatment group had TACE surgery followed by a one year nucleoside analog treatment.7 Patients were given Lamivudine (100mg PO QID and 16 Patients were given Entecavir (0.5mg PO QID) .There was no difference in the conventional treatment between treatment and control groups.Results After 48 and 96 weeks of treatment, the decrease in HBVDNA level and the treatment response was better among the patients treated with Entecavir than Lamivudine.The HBV DNA negativity after 48 weeks of treatment was 71.4% and 81.2% in the Entecavir and Lamivudine treated patients, respectively (P<0.05) .The HBVDNA negativity was higher than the control group.Furthermore the liver function tests and the Child-Pugh scores were improved in the treatment group.The 48th and 96th weeks of survival were 78.2% and 60.8% in the treatment group, and 50.0% and 36.3% in the control group, respectively (P<0.05) .Conclusion The anti-viral treatment of HCC with active liver cirrhosis using Lamivudine and Entecavir effectively inhibits the replication of HBV and improves the patient's survival.
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Key words:
- carcinoma /
- hepatocellular /
- liver cirrhosis /
- lamivudine /
- entecavir
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