核苷(酸)类似物在经肝动脉介入治疗乙型肝炎病毒相关性肝细胞癌中的作用  

Application of nucleos(t)ide analogues in transarterial interventional therapy for hepatitis B virus related hepatocellular carcinoma

作　　者：闫东[1] 姚雪松[1] 高钦宗 刘德忠[1] 曾辉英[1] 李忱瑞[1] 史仲华[1] 郭彦君[1] 李槐[1] 

机构地区：[1]中国医学科学院肿瘤医院介入治疗科,北京100021

出　　处：《中国介入影像与治疗学》2015年第5期293-297,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：中国医学科学院肿瘤医院院内科研课题(LC2008B52)

摘　　要：目的 探讨核苷（酸）类似物在乙型肝炎病毒（HBV）相关肝细胞癌（HCC）经肝动脉介入治疗（TAIT）中的应用价值。方法 入组60例HBsAg阳性且不能手术切除的HCC患者,配对分为核苷（酸）类似物治疗组（A组）和常规保肝降酶组（B组）,每组30例。对两组进行常规TAIT同时,给予常规保肝降酶治疗,A组同时联合核苷（酸）类药物行抗病毒治疗。比较两组的生存率,分析预后影响因素。结果 A组核苷（酸）类似物抗病毒初始治疗药物选择：恩替卡韦14例,拉米夫定8例,阿德福韦酯8例,其中4例患者出现病毒学突破,经加用另一核苷（酸）类似物后实现病毒持续抑制。B组中,13例（13/30,43.33%）患者分别在第1～9次TAIT后发生病毒学突破,中位突破时间为5.52个月（4次TAIT后）。两组共死亡48例,其中A组20例,B组28例,中位生存期分别为29.63、14.77个月（χ2=7.51,P=0.01）。A组和B组中BCLC分期C期患者中位生存期分别为23.63、8.07个月（2χ=7.11,P=0.01）。Cox回归模型分析显示：患者是否行核苷（酸）类似物抗病毒治疗、肝功能分级、肝癌BCLC分期影响患者预后。未发生核苷（酸）类药物相关严重不良反应。结论 采用TAIT治疗HBV相关HCC时联合应用核苷（酸）类药物安全、有效。Objective To explore the value of nucleos （t） ide analogues in transarterial interventional therapy （TAIT） for hepatitis B virus （HBV） related hepatocellular carcinoma （HCC）. Methods Totally 60 unresectable HCC patients with HBsAg positive were divided into two groups （group A and group B, each n=30）. All of them underwent TAIT and sup- portive liver protection therapy, besides the nucleos （t） ide analogues was given in group A. The survival were compared between two groups, and the prognostic factors were analyzed. Results In group A, the entecavir were given to 14 pa- tients, 8 patients with lamivudine, 8 patients with adefovir dipivoxil, firstly, of which 4 patients had virus breakthrough and virus was contained after another nucleos （t） ide analogues were given. In the group B, 13 cases developed virus break- through during cycle 1 to cycle 9, with a median time of 5.52 months. A total of 48 patients died, i.e. 20 in group A and 28 in group B. In group A and group B, the median survival was 29.63 and 14.73 months （X2=7. 51,P=0. 01）. Patients with stage C according to BCLC staging had a median survival of 23.63 and 8.07 months, respectively （X2=7. 11,P= 0.01）. Cox regress model identified the nucleos （t） ide analogues, liver function stage, BCLC stage as prognosis factors. No severe adverse effects related with nucleos （t） ide analogues was observed. Conclusion The nucleos （t） ide analogues is effective and safe in the TAIT for HBV-associated HCC.

关 键 词：癌 肝细胞 肝炎 乙型 经肝动脉介入治疗 核苷(酸)类药物 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学]