持续HBsAg高定量与经抗病毒治疗后发生肝癌的关系  

Correlation between the persistent high HBsAg quantity and HCC after anti-viral therapy

作　　者：张绍全[1] 麦丽[1] 严颖[1] 潘兴飞[2] 

机构地区：[1]中山大学附属第三医院感染科,广东广州510630 [2]广州医科大学附属第三医院感染科,广东广州510150

出　　处：《中国卫生检验杂志》2016年第12期1673-1675,1679,共4页Chinese Journal of Health Laboratory Technology

基　　金：国家自然科学基金(81401306);广东省医学科研基金(A2013210)

摘　　要：目的 HBV复制与肝癌发生密切相关,抗病毒治疗可降低HBV相关肝癌发生率。本文探讨经抗病毒治疗后HBV DNA阴性而发生肝癌的病例的临床及病毒动力学特点。方法回顾性分析42例经核苷类似物治疗HBV DNA阴性的肝癌患者,分析患者HBV DNA阴性及诊断为肝癌时血清学、病毒学、肝硬化程度、AFP及影像学检查情况。结果42例患者确诊肝癌时,ALT从基线的中位数42.5 U/L下降到确诊肝癌时的29.0 U/L,差异有统计学意义(F=9.316,P=0.002)。APRI值基线均数为2.65,确诊肝癌时APRI值均数为1.02,差异有统计学意义(F=7.617,P=0.007)。治疗前HBsAg中位数为4 766.5 U/L,确诊为肝癌后HBsAg中位数为5 982 U/L,两者比较差异无统计学意义(F=2.258,P>0.05)。结论抗病毒治疗可以改善慢性乙型肝炎患者肝脏炎症和纤维化程度,但不能避免肝癌的发生。持续HBsAg高定量是经抗病毒治疗后HBV DNA阴性而发生肝癌的危险因素。Objective Hepatitis B virus （HBV） replication is significantly associated with the occurrence of hepatocellular carcinoma. Anti - viral therapy can reduce the incidence of HBV - related hepatocellular carcinoma（HCC）. We discuss the clinical and viral dynamics characteristics of DNA HBV negative patients with hepatocellular carcinoma after antiviral treatment. Methods 42 cases of HCC patients with nucleos（t）ide analogues treatment, whose HBV DNA was negative, were retrospectively analyzed. To compare the serological, viral, liver cirrhosis degree, AFP and imaging findings in patients when HBV DNA were negative and when they were diagnosed as HCC. Results ALT median was 42.5U/L at baseline, and decreased to 29.0 U/L when 42 HCC cases were diagnosed, with the differences statistically significant （ F = 9. 316, P = 0. 002 ）. APRI mean at baseline was 2.65, and decreased to 1.02 when HCC was diagnosed, with the differences statistically significant（ F = 7. 617, P =0.007）. HBsAg median at baseline was 4 766.5 U/L, and was 5 982 U/L when HCC was diagnosed, there was no statistical significance on the differences between before antiviral therapy and after therapy（ F = 2. 258, P 〉0.05 ）. Conclusion Anti - viral therapy could alleviate liver inflammation and fibrosis in patients with chronic hepatitis B, but it could not avoid the occurrence of HCC. Persistent high HBsAg value is a risk factor for the occurrence of HCC after anti - viral therapy with HBV DNA negative.

关 键 词：抗病毒治疗 慢乙型肝炎 HBSAG定量 肝癌 

分 类 号：R512.62[医药卫生—内科学]