乙型肝炎病毒感染及抗病毒治疗对肝细胞癌微血管侵犯的影响  

Impact of hepatitis B virus infection and antiviral therapy on microvascular invasion in hepatocellular carcinoma

作　　者：曲超 刘奎[1] 王一休 刘鹏[1] 李坤[1] 胡维昱[1] 王祖森[1] 曹景玉[1] QU Chao;LIU Kui;WANG Yixiu;LIU Peng;LI Kun;HU Weiyu;WANG Zusen;CAO Jingyu(Deoartment of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China)

机构地区：[1]青岛大学附属医院肝胆胰外科,山东青岛266003

出　　处：《中国普通外科杂志》2019年第1期10-17,共8页China Journal of General Surgery

基　　金：2017年山东省医药卫生科技发展计划资助项目(2017WS319)

摘　　要：目的:探讨乙型肝炎病毒(HBV)感染及抗病毒治疗对肝细胞癌微血管侵犯(MVI)形成的影响。方法:回顾性分析青岛大学附属医院2015年1月—2017年12月660例行根治性肝切除手术的肝细胞癌患者的临床及病理资料。结果:660例患者中,MVI发生率为46.8%(309/660)。单因素分析显示,MVI的形成与HBsAg阳性、可检测的HBV DNA载量以及是否行抗病毒治疗有关,此外,还与患者的年龄、性别、术前AFP、肿瘤标志物、肝功能指标、组织学分级、肿瘤大小与数目、包膜是否完整以及是否存在卫星结节有关(均P<0.05)。在HBV相关患者中,多因素Logistic回归分析结果显示:可检测的HBV DNA载量(OR=5.33,P<0.001)为MVI的独立危险因素,而抗病毒治疗半年以上(OR=0.37,P=0.002)为MVI的独立保护因素,MVI的其他独立影响因素还包括性别、AFP水平、肿瘤直径、组织学分级、包膜不完整、存在卫星结节(均P<0.05)。重度MVI患者有明显高的HBV感染、高HBV DNA载量(>100 IU/mL)以及未行抗病毒治疗的比例较轻度MVI及无MVI患者明显升高(均P<0.05),此外,轻度MVI患者中肝硬化比例较高(80.0%)。结论:HBV感染与HBV DNA水平是肝细胞癌MVI的形成的重要因素,抗病毒治疗可能对MVI的形成有预防作用。Objective: To investigate the influence of hepatitis B virus(HBV) infection and antiviral treatment on the formation of microvascular invasion(MVI) in hepatocellular carcinoma.Methods: The clinical and pathological data of 660 patients with hepatocellular carcinoma who underwent radical hepatectomy from January 2015 to December 2017 in Affiliated Hospital of Qingdao University were retrospectively analyzed. Results: In the 660 patients, the incidence of MVI was 46.8%(309/660). Results of univariate analysis showed that MVI formation was significantly related to positive HBsAg, detectable HBV DNA load, and whether or not underwent antiviral treatment, and was also associated with the age, sex, preoperative levels of AFP, tumor markers and liver function parameters, histological grade, the size and number of lesions, capsule integrity and presence or absence of satellite nodules(all P<0.05). In the HBV-related patients, the results of multivariate Logistic regression analysis showed that detectable HBV DNA load was an independent risk factor for MVI(OR=5.33, P<0.001), while antiviral therapy for more than half a year was an independent protective factor against MVI(OR=0.37, P=0.002), and other independent influential factors for MVI were included sex, AFP level, tumor diameter, histological grade, incomplete capsule and presence of satellite nodules(all P<0.05). In patients with severe MVI, the proportions of HBV infection, high detectable HBV DNA load(>100 IU/mL) and cases without antiviral treatment were significantly increased compared with those with mild or without MVI(all P<0.05), moreover, the proportion of cases with liver cirrhosis was increased in patients with mild MVI(80.0%).Conclusion: HBV infection and HBV DNA level are independent factors for MVI formation in hepatocellular carcinoma and antiviral therapy may have a preventive effect against the formation of MVI.

关 键 词：癌 肝细胞 乙型肝炎病毒 肿瘤侵润 微血管 

分 类 号：R735.7[医药卫生—肿瘤]