原发性肝癌局部化疗后肝炎及乙型肝炎抗病毒治疗的临床研究  

A clinical research of hepatitis and antiviral therapy in hepatocellular carcinoma patients undergoing chemotherapy

作　　者：张天成[1] 谭龙益[2] 

机构地区：[1]上海交通大学附属上海市第一人民医院宝山分院消化科,上海200940 [2]上海交通大学附属上海市第一人民医院宝山分院检验科,上海200940

出　　处：《胃肠病学和肝病学杂志》2011年第1期36-39,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：上海市宝山区科学技术委员会立项课题(编号:08-E-29)

摘　　要：目的分析肝癌化疗后肝炎发生的病因,探讨核苷类似物抗病毒治疗对化疗后乙肝病毒再激活肝炎疗效。方法收集明确诊断乙型肝炎后肝细胞癌患者120例,男108例,女12例,年龄28~85岁,平均（53.88±12.16）岁。肝癌患者均接受1次经导管肝动脉化疗栓塞（TACE）治疗;并分为抗病毒治疗组35例;未行抗病毒治疗组85例。抗病毒组中TACE前2周23例服拉米夫定;12例服阿德福韦酯,维持抗病毒治疗TACE后4周为观察终点。随访4周后,监测2组患者TACE前后肝功能及HBV载量水平变化和肝炎发生情况,观察核苷类似物抗病毒治疗HBV再激活肝炎的疗效。结果肝细胞癌患者化疗后HBV再激活33例,化疗后未再激活87例,HBV再激活发生率为27.50%。HBV再激活肝炎23例,发生率为69.70%;化疗药物性肝炎11例,发生率为12.64%,2种肝炎的发生之间差异有统计学意义（P=0.00）。抗病毒治疗组与未抗病毒组之间HBV再激活肝炎的发生差异有统计学意义（2χ=5.78,P〈0.05）,2组间药物性肝炎的发生差异无统计学意义。结论肝细胞癌化疗后发生HBV再激活肝炎和化疗药物性肝炎;HBV再激活肝炎的发生较化疗药物性肝炎多。核苷类似物（拉米夫定/阿德福韦酯）抗病毒治疗可明显降低肝细胞癌患者化疗后HBV再激活肝炎的发生。Objective To analyze the cause of hepatitis in hepatocellular carcinoma（HCC） patients receiving transarterial chemo-embolization（TACE）,and observe the effect of the nucleoside analogues lamivudine,or adefovir dipivoxil antiviral therapy on HBV reactivation hepatitis.Methods One hundred and twenty HCC patients,including 108 male and 12 female ranged 28~85 years,whose average age were（53.88±12.16） years,received TACE treatment once.Thirty-five cases took lamivudine or adefovir before receiving TACE 2 weeks and maintained antiviral therapy for 4 weeks;the other 85 cases were not given antiviral drugs.Followed up for 4 weeks, liver function and HBV DNA level were monitored in the two groups,the efficacy was observed on HBV reactivation hepatitis.Results HCC patients with HBV reactivation after chemotherapy were 33 cases,HBV reactivation rate was 27.50%.HBV reactivation hepatitis were 23 cases,the incidence was 69.70%;drug-induced hepatitis were 11 cases,the incidence was 12.64 %.The occurrence of the two groups had significantly statistical difference（P=0.00）.Among the antiviral treatment and no antiviral treatment groups,the incidence of HBV reactivation hepatitis had significant difference（χ2=5.78,P0.05）,while the incidence of drug-induced hepatitis had no significant difference（P=0.526）.So lamivudine or adefovir dipivoxil antiviral therapy could significantly reduce the incidence of HBV reactivation hepatitis.Conclusion HCC receiving TACE occurred two kinds of hepatitis： HBV reactivation hepatitis and chemotherapy drug-induced hepatitis;HBV reactivation hepatitis occurred more than chemotherapy drug-induced hepatitis.Nucleoside analogues（lamivudine/adefovir dipivoxil） antiviral therapy can significantly reduce the incidence of HBV reactivation hepatitis.

关 键 词：肝细胞癌 TACE 乙肝病毒再激活肝炎 药物性肝炎 

分 类 号：R735.7[医药卫生—肿瘤]