原发性肝癌精确放疗致乙型肝炎病毒再激活分析  

Analysis of hepatitis B virus reactivation induced by precise radiotherapy in patients with primary liver cancer

作　　者：黄伟[1] 卢彦达[2,3] 张炜[1] 张健[1] 周涛[1] 李洪升[1] 李宝生[1] 于金明[1] 

机构地区：[1]山东省放射肿瘤学重点实验室山东省肿瘤医院放疗六病区,济南250117 [2]江西九江市第三人民医院肿瘤中心,332000 [3]海南医学院附属医院放疗科

出　　处：《中华放射肿瘤学杂志》2013年第3期193-197,共5页Chinese Journal of Radiation Oncology

摘　　要：目的探讨原发性肝癌（PLC）患者精确放疗后乙型肝炎病毒（HBV）再激活的临床特点，并分析其危险因素。方法回顾分析69例HBsAg阳性PLC患者行精确放疗并发HBV再激活的临床特点。所有患者放疗前均做基线血常规、肝功能、肾功能、甲胎蛋白、HBV标志物、HBVDNA定量测定。放疗中及后血常规检查每2周检测1次，肝功能、甲胎蛋白、HBV标志物、HBVDNA定量测定每4周检测1次，持续至放疗完成后至少12周。Logistic法评估临床各项指标对HBV再激活的影响。结果69例中发生放射性肝病12例（17％），HBV再激活发生17例（25％），HBV再激活相关肝炎发生15例（22％）。Logistic法评估结果显示基线血清HBVDNA水平为HBV再激活发生的危险因素。结论PLC患者精确放疗后可引起HBV再激活，基线血清HBVDNA水平为其独立危险因素。发生HBV再激活相关肝炎患者即使及时采用抗病毒治疗预后仍不良。Objective To investigate the clinical features of hepatitis B virus （HBV） reactivation after precise radiotherapy in patients with primary liver cancer （PLC） and analyze the risk factors for HBV reactivation. Methods A retrospective analysis was performed on the clinical data of 69 hepatitis B surface antigen （HBsAg）-positive patients with PLC, some of whom had HBV reactivation after precise radiotherapy. Before radiotherapy, all patients underwent baseline examinations, including blood routine, liver function test, renal function test, and quantifieations of serum alpha-fetoprotein （AFP）, serum HBV markers, and serum HBV DNA. During radiotherapy and within 12 weeks after radiotherapy, blood routine was performed biweekly, and liver function test, renal function test, and quantifications of serum AFP, serum HBV markers, and serum HBV DNA were performed once every four weeks. Logistic regression analysis was used to evaluate the association of the indices with HBV reactivation. Results Of the 69 patients, 12 （ 17% ） had radiation-induced liver disease, 17 （25%） had HBV reactivation, and 15 （22%） developed hepatitis due to HBV reactivation. The logistic regression analysis showed that baseline serum HBV DNA level was the risk factor for HBV reactivation after precise radiotherapy. Conclusions HBV reactivation may occur after precise radiotherapy in patients with PLC, and baseline serum HBV DNA level is the independent risk factor for HBV reactivation. The patients who develop hepatitis due to HBV reactivation have poor prognosis even if they receive antiviral therapy in time.

关 键 词：肝肿瘤 三维适形放射疗法 放射性肝病 乙型肝炎病毒 

分 类 号：R735.7[医药卫生—肿瘤]