原发性肝癌行肝动脉化疗栓塞术后乙肝病毒再激活的危险因素分析  

Risk factor for hepatitis B virus reactivation in primary hepatocellular carcinoma after transcatheter arterial chemoembolization

作　　者：王英民[1] 王洪[1] 周瑛[1] 胡庭阳[1] 

机构地区：[1]浙江省人民医院感染科,杭州310014

出　　处：《浙江医学》2009年第4期412-413,416,共3页Zhejiang Medical Journal

摘　　要：目的探讨原发性肝癌患者行肝动脉化疗栓塞术（TACE）后乙肝病毒（HBV）再激活的临床特点，并分析其危险因素。方法回顾性分析102例行TACE术后的中晚期肝癌患者并发HBV再激活的临床特点，并应用多因素Logistic回归分析HBV再激活的独立危险因子。结果TACE术后出现HBV再激活者27例，其中HBeAg和HBV—DNA阳性者18例；HBeAb和HBV—DNA阳性5例；HBeAb阳性，HBV—DNA阴性者2例；HBeAg阴性、HBV—DNA阳性者2例。单因素分析显示，HBsAg阳性、HBeAg阳性和HBV—DNA阳性是HBV再激活的危险因子，其比数比分别为8．66、26．44和58．03；95％可信区间分别为8．6～16．8（p〈0．05）、9．8～22，6（p〈0.01）和995～95．6（p〈0.01）；多因素Logistic回归分析显示，95％可信区间为995～2266（P〈0.01），提示HBV—DNA阳性为HBV再激活的独立危险因子。结论HBV—DNA阳性、HBsAg阳性和HBeAg阳性为原发性肝癌患者行TACE术后HBV再激活的危险因素，其中HBV—DNA阳性为HBV再激活的独立危险因子。Objective To identify the the risk factors for hepatitis B virus （HBV） reactivation in primary hepatocellular carcinoma （PHC） after transcatheter arterial chemoembolization （TACE）. Methods Clinic data of 102 PHC patients who underwent TACE were retrospective studied. In multivariate logistic regression model analysis, possible risk factors included serum levels of alanine aminotransferase, asparate aminotransferase, total bilirubin, HBV DNA, HbeAg and protocol of TACE. Results Twenty seven patients developed HBV reactivation, among whom 18 were HBV DNA and HbeAg positive, 5 were HbeAb and HBV DNA positive, 2 were HbeAb positive and HBV DNA negative, 2 patients were HbeAg negative and HBV DNA positive. Patients who developed HBV reactivation were more likely to have HBV DNA positive （OR=8.66, 95% CI 8.6-16.8,P〈0.05）, HbeAg positive （OR=26.44, 95% CI 9.8-22.6, P〈0.01） and HbsAg positive （OR=58.03, 95% CI 9.95-95.6,P〈0.01）. HBV DNA positivity was an independent risk factor for patients to develop HBV reactivation. Conclusion The study shows that positive HBV DNA, HbeAg and HbsAg are the risk factors for development of HBV reactivation in PHC patients after TACE, among which positive HBV DNA is an independent risk factor.

关 键 词：原发性肝癌 肝动脉化疗栓塞术 乙肝病毒 再激活 

分 类 号：R563.1[医药卫生—呼吸系统] R735.7[医药卫生—内科学]