乙肝相关性肝癌手术切除和射频消融围手术期乙肝病毒DNA的变化  

Hepatitis B reactivation in hepatocellular carcinoma patients after hepatic resection vs radiofrequency ablation

作　　者：徐教邦[1] 李国强[1] 李鹏[1] 赵飞[1] 袁庆忠[1] 张建[1] Xu Jiaobang Li Guoqiang Li Peng Zhao Fei Yuan Qingzhong Zhang Jian(Department of Hepatobiliary Surgery, Shengli Oilfield Central Hospital, Dongying 257034, Chin)

机构地区：[1]东营市胜利油田中心医院肝胆外科,山东省257034

出　　处：《中华普通外科杂志》2016年第12期1018-1021,共4页Chinese Journal of General Surgery

基　　金：吴阶平医学基金会临床科研专项基金资助项目（320.6750.13237）

摘　　要：目的探讨肿瘤直径≤5cm小肝癌患者射频消融与手术切除围手术期HBVDNA变化。方法回顾性分析2006年9月至2013年1月收治的339例肿瘤≤5cm肝癌患者的资料，患者分为手术组（193例）和射频组（146例），对影响HBV激活的因素通过logistic回归单因素、多因素分析、分层，检验分别分析抗病毒与未抗病毒治疗在手术组与射频组HBV的激活率变化，并对比分析随访患者CD3＋、CD4＋、CD8＋、CD4＋／CD8＋和NK细胞比例。结果（1）单因素和多因素分析显示，抗病毒治疗、Child—Pugh分级、肿瘤多发及治疗方式（射频／手术）是HBV激活的独立危险因素（P〈0．05）；（2）抗病毒治疗患者HBV激活率低于未抗病毒治疗患者（16／181比25／158，X2=3．869，P=0．049），未抗病毒治疗患者中手术组HBV激活率高于射频组（20／92比5／66,X2=5．788，P=0．016），而抗病毒治疗患者中手术与射频组比较差异无统计学意义（10／101比6／80，疋。=0．319，P=0．572）；（3）手术组与射频组术后7d患者CD3＋、CD4＋、CD4＋／CD8＋及NK细胞比例有不同程度的降低（P〈0．05），未抗病毒治疗患者射频组术后7d CD3＋、CD4＋、CD4＋／CD8＋及NK细胞比例高于手术组（P〈0．05）。结论直径≤5cm的小肝癌患者行射频治疗比手术切除术后的免疫细胞比例较低，术前行抗病毒治疗可部分缓解免疫抑制状态，降低术后HBV激活率。Objective To study hepatitis B virus （HBV） reactivation and related risk factors for ≤ 5 em hepatocellular carcinoma （HCC） by radiofrequency ablation （RFA） or hepatic resection. Methods From Sep 2006 to Jan 2013,193 patients received hepatectomy and 146 patients received RFA. Univariate and multivariate logistic regression analysis was used to assess risk factors. Stratified X2 test for HBV reactivation, Unpaired student＇s t-test for CD4 ＋ , CD8 ＋ , CD4 ＋/CD8 ＋ and NK cell proportions. Results （ 1 ） Antiviral therapy, Child-Pugh grade, vascular invasion and treatment modality were significant risk factors of HBV reactivation （ P 〈 0. 05 ）. （2） HBV reactivation was lower in patients receiving antiviral therapy than those who did not （ 16/181 vs. 25/158, X2 = 3. 869, P = 0.049）, the reactivation in hepateetomy group was higher than RFA group in those not using antiviral therapy （20/92 vs. 5/66 ,X2 = 5. 788,P =0. 016） , but the difference was not significant in the antiviral therapy patients （10/101 vs. 6/80,X2 = 0. 319,P = 0. 572）. （3） CD3＋ , CD4＋ , CD4＋/CD8＋ and NK cell proportions after 7 days treatment decreased in different degree for both hepatic resection and RFA group with or without antiviral therapy （ P 〈0. 05 ）. For patients who did not received antiviral therapy,the proportions of RFA after 7 days treatment were higher than the hepatic resection group （ P 〈0. 05 ）. Conclusions Compared with ≤5 cm carcinoma treated by RFA, hepatic resection decreased the proportions of immune cells, preoperative antiviral therapy relieves immune suppression, decreases the incidence of HBV reactivation.

关 键 词：癌 肝细胞 乙型肝炎病毒 肝切除术 射频消融 

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