不同抗病毒药物联合TACE治疗HBV相关性肝癌临床疗效分析  

Clinical analysis of different antiviral agents combined with TACE in the treatment of HBV-related liver cancer

作　　者：李学达[1] 杨莉莉[1] 张伟[1] 李群[1] 李子祥[1] Li Xue-da;Yang Li-li;Zhang Wei;Li Qun;Li Zi-xiang(Interventional Medical Center of The Affiliated Hospital of Qingdao university,Qingdao,Shandong,266555,China)

机构地区：[1]青岛大学附属医院介入医学中心,山东青岛266555

出　　处：《当代医学》2017年第23期17-20,共4页Contemporary Medicine

摘　　要：目的评估不同核苷酸类似物(NAs)抗病毒药物联合TACE治疗HBV相关性肝癌的临床效果及耐药率分析。方法回顾性分析2012年1月~2016年1月本院接受不同NAs抗病毒药物联合TACE治疗的中晚期HBV相关性肝癌患者142例,分为拉米夫定(LAM)、阿德福韦酯(ADV)、恩替卡韦(ETV)3组。所有病人术前开始长期口服抗病毒药物,根据局部肿瘤控制情况重复进行TACE治疗。比较3组患者术后HBV DNA转阴时间及耐药率差异。组间比较采用t检验或c2检验。结果 LAM、ADV、ETV 3组HBV DNA平均转阴时间分别为5.23、4.00、3.62天。LAM组转阴时间明显长于ADV、ETV(P<0.05),ADV组转阴时间与ETV组比较差异无统计学意义。服药12个月3组耐药率分别为6.67%、4.87%、3.33%,服药12个月、8个月LAM组耐药率明显高于ADV组、ETV组(P<0.05),ADV组与ETV组比较差异无统计学意义。服药24个月及24个月以上,ETV组无耐药病例,耐药率明显低于LAM组及ADV组(P<0.05),ADV组明显低于LAM组(P<0.05)。结论恩替卡韦抗病毒治疗起效快、耐药率低,首选恩替卡韦联合TACE治疗高病毒载量的中晚期HBV相关性肝癌患者。对于经济基础差、预期生存期短的病人可选择阿德福韦酯抗病毒治疗。Objective To evaluate the efficacy and resistant rate of antiviral therapy of different nucleostide analogues with TACE on high HBVDNA levels HBV-related liver cancer.Methods A retrospective analysis was performed on the clinical data of142HCC patients with high HBVDNA levels who underwent antiviral therapy and TACE.These patients were divided into three groups:LAM group、ADV group、ETV group.All patientsstarted taking antiviral agents before TACE.According to the local tumor control,repeated TACE treatment.All patients were followed up afteroperation,and the three groups were compared in terms of HBV DNA level and resistant rate.Comparison between the three groups was made by ttest or c2test.Results The HBV DNA negative time of the three was5.23,4.00,3.62day,respectively.The HBV DNA negative time of LAM groupwas significantly longer than ADV group and ETV group(P<0.05),there was no significant difference between ADV group and ETV group.Therewas no resistant patient within6months after antiviral therapy in the three groups.12months after antiviral therapy,the resistant rate of the threewas6.67%,4.87%,3.33%,LAM group was significantly higher than ADV group and ETV group(P<0.05),there was no significant difference betweenADV group and ETV group.24months and24months above after antiviral therapy,ETV group has no resistant patient,its resistant rate wassignificantly lower than LAM group and ADV group;there was significant difference between group LAM and ADV group(P<0.05).ConclusionETV has quick effect and low resistance,its the first choice combined with TACE on HBV-related liver cancer.For the poor and short expected survivalpatients,ADV is also the right choice.

关 键 词：肝细胞肝癌 抗病毒药物 乙肝病毒DNA载量 转阴率 耐药率 

分 类 号：R512.62[医药卫生—内科学]