晚期肝细胞癌患者HBsAg水平与预后的关系  

The relationship between HBsAg levels and prognosis in advanced hepatocellular carcinoma patients

作　　者：赵涵 陈铿[1] 李凌华[1] 张影[1] 李平红 刘惠媛[1] 唐小平[1] ZHAO Han;CHEN Keng;LI Linghua;ZHANG Ying;LI Pinghong;LIU Huiyuan;TANG Xiaoping(Infectious Diseases Center,Guangzhou Eighth People’s Hospital,Guangzhou 510060,China)

机构地区：[1]广州市第八人民医院感染病中心,广东广州510060

出　　处：《胃肠病学和肝病学杂志》2020年第6期647-653,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金(81770593);广州市科技项目(201508020262);广州市第八人民医院院内科研立项(2014BY002)。

摘　　要：目的探讨乙型肝炎表面抗原(HBsAg)水平是否与肝细胞癌(hepatocellular carcinoma,HCC)患者的总体生存和介入后乙型肝炎病毒(HBV)的再活化有关。方法对2013年12月至2018年12月登记的HBV相关性HCC患者216例进行分析。采用统计学分析方法探讨HBsAg水平与临床特征参数的关系及预后影响。结果血清HBsAg与抗病毒治疗(P<0.001)、HBV经动脉化疗栓塞(TACE)1~2个月后脱氧核糖核酸(HBV DNA)再活化(P<0.001)、ALT水平(P=0.028)显著相关。抗病毒治疗与HBV再活化相关(P<0.001),患者接受抗病毒治疗可以降低HBV再活化(P<0.001)。然而,我们也观察到血清HBsAg与抗病毒治疗之间的相关性(P<0.001)。此外,我们检测到HBsAg水平较高的HCC患者比对照组更易发生HBV再活化(P<0.001)。单因素和多因素分析表明,血清HBsAg水平是一个独立的预后因素(P=0.002)。结论HBsAg水平可能是影响HCC预后的潜在因素。HBsAg水平高、HBV DNA检测不出的患者应在TACE前先行抗病毒治疗。Objective To investigate whether or not serum hepatitis B surface antigen(HBsAg)levels are related to the overall survival(OS)and the reactivation of the hepatitis B virus(HBV)following hepatocellular carcinoma(HCC)patients undergoing transarterial chemoembolization(TACE).Methods Among patients with HBV related HCC registered from Dec.2013 to Dec.2018,216 of them were eligible for analysis.Statistical analysis was used to explore the prognostic effect and the associations of HBsAg levels with clinicopathological parameters.Results The serum HBsAg was significantly correlated with antiviral therapy(P<0.001),HBV DNA reactivation after TACE 1-2 months(P<0.001)and alanine aminotransferase(ALT)levels(P=0.028).Antiviral therapy was correlated with HBV reactivation(P<0.001),and the patients receiving antiviral therapy reduced HBV reactivation compared with patients without prophylaxis(P<0.001).However,there was a relationship between serum HBsAg levels and antiviral therapy(P<0.001).Furthermore,the high serum HBsAg levels of HCC patients were more frequent episodes of HBV reactivation than those in control patients(P<0.001).Univariate and multivariate analyses indicated that serum HBsAg level was an independent prognostic factor(P=0.002).Conclusion The HBsAg levels could be a potential prognostic factor of HCC.High HBsAg level patients with undetectable HBV DNA should receive pre-emptive antiviral before TACE.

关 键 词：乙型肝炎表面抗原 肝细胞癌 HBV DNA阴性 预后 

分 类 号：R735.7[医药卫生—肿瘤]