肝移植术后原发性肝癌复发与乙型肝炎病毒再感染的关系  

The relationship between hepatocellular carcinoma recurrence and hepatitis B virus recurrence after liver transplantation

作　　者：李敏如[1] 易述红[1] 蔡常洁[1] 易慧敏[1] 安玉玲[1] 危敏[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心、中山大学器官移植研究所,广州510630

出　　处：《中华肝脏病杂志》2011年第4期271-274,共4页Chinese Journal of Hepatology

基　　金：国家重点基础研究发展计划（973计划,2009CB522404）,国家十一五科技重大专项（2008ZX10002-026）,2007-2009年度卫生部部属（管）医院临床学科重点项目,国家自然科学基金（30972914）

摘　　要：目的 探讨肝移植术后原发性肝癌复发与HBV再感染的关系.方法 对2004年1月-2008年12月在中山大学附属第三医院因乙型肝炎相关性终末期肝病行肝移植手术并长期随访的340例患者回顾性分析.患者被列入肝移植等待名单后给予核苷（酸）类似物抗病毒治疗,术中和术后均给予核苷（酸）类似物联合低剂量乙型肝炎免疫球蛋白进行预防.术后定期随访并监测患者HBV再感染的发生率及生存率,用多因素COX回归分析筛选出影响术后HBV再感染的危险因素.计量资料用t检验、计数资料用x2检验进行统计学处理.用Kaplan-Meier方法进行生存率分析,对HBV再感染危险因素用COX多因素回归分析,对HBV再感染与原发性肝癌复发的时间进行Spearman线性相关分析.结果 340例患者术后发生HBV再感染33例,术后1、3、5年再感染率分别为7%、10%、13%.HBV再感染的时间为1～21个月,中位数为5个月.原发病为原发性肝癌（风险比为2.98;95%可信区间为1.08～8.25,P＜0.05）、术前HBV DNA载量＞5log10拷贝/ml（风险比为3.99;95%可信区间为1.85～8.62,P＜0.01）是发生HBV再感染的危险因素.原发性肝癌复发者HBV再感染发生率高于未复发者,分别为27.9%和8.7%（风险比为4.58; 95%可信区间为1.88～11.12;P＜0.01）.12例患者肝移植术后发生HBV再感染和原发性肝癌复发,两者的复发时间具有相关性（r=0.583,P＜0.05）.结论肝移植术后原发性肝癌复发是HBV再感染的危险因素.Objective To investigate the relationship between hepatocellular carcinoma （HCC）recurrence and hepatitis B virus （HBV） recurrence. Method The clinical data of 340 patients underwent liver transplantation due to HBV related end-stage liver disease and received long-term follow up in our hospital from Jan 2004 to Dec 2008 were retrospectively analyzed. All patients received nucleoside analogues therapy formally before entering into the waiting list and nucleoside analogues combined low-dose HBIG therapy during and after transplantation. Patients were regularly followed up at the outpatient, monitoring the HBV recurrence and survival. Multivariate Cox regression analysis was used to evaluate the risk factors for hepatitis recurrence. Result 33 patients suffered from HBV recurrence post transplantation.The 1-, 3- and 5- year recurrence rates were 7.0%, 10% and 13% respectively. The median HBV recurrence time was 5 months （1-21 months）. COX regression analysis revealed that risk factors for HBV recurrence were HCC （HR = 2.98; 95% CI 1.08-8.25; P＜0.05） and pre-transplantation HBV-DNA load over 5 log10 copies/ml （HR = 3.99; 95% CI 1.85-8.62; P＜0.01）. Further stratified analysis showed that patients who suffered from carcinoma recurrence had a higher incidence of HBV recurrence than those who did not, which were 27.9% and 8.7% （HR =- 4.58;95% CI 1.88-11.12; P＜0.01） respectively. 12 patients suffered from both HCC and HBV recurrence. Spearman correlation analysis demonstrated a strong correlation between HBV and HCC recurrence times （r= 0.583, P＜0.05）. Conclusion Post transplantation HCC recurrence is a risk factor for HBV recurrence.

关 键 词：肝移植 肝炎病毒 乙型 危险因素 

分 类 号：R735[医药卫生—肿瘤] R51[医药卫生—临床医学]