精确放疗治疗原发性肝癌后HBV再激活的影响因素研究  

Study on the influencing factors of HBV reactivation after precise radiotherapy for primary liver cancer

作　　者：王骁 周锡建 顾培 WANG Xiao;ZHOU Xi-jian;GU Pei(Hematology Oncology,904 th Hospital of the Joint Service Support Force of the Chinese people′s Liberation Army,Wuxi Jiangsu 214000,China)

机构地区：[1]解放军联勤保障部队第九○四医院血液肿瘤科,江苏无锡1214000 [2]南通市肿瘤医院放疗科

出　　处：《肝脏》2020年第7期702-704,713,共4页Chinese Hepatology

基　　金：南通市科技项目(HS2015003)。

摘　　要：目的探讨精确放疗治疗原发性肝癌(PLC)后乙型肝炎病毒(HBV)再激活的影响因素。方法2016年5月—2019年5月解放军联勤保障部队第九○四医院收治的PLC患者138例,均接受精确放疗治疗。统计患者肿瘤直径、肝功能Child-Pugh分级、HBV?DNA等一般资料,分析精确放疗后HBV再激活发生情况,并采用多因素logistic回归分析PLC患者精确放疗后HBV再激活的独立影响因素。结果138例PLC患者均行精确放疗,有34例(24.6%)发生HBV再激活,其中精确放疗后4周发生6例(4.3%),8周发生16例(11.6%),12周发生12例(8.7%),均纳入HBV再激活组;104例(75.4%)未发生HBV再激活,归入HBV未激活组。HBV再激活组肝功能Child-Pugh分级为B级所占比例为58.8%,显著高于HBV未激活组的14.4%(P<0.05);HBV再激活组血清HBV DNA>1.0×104拷贝/mL所占比例为50.0%,显著高于HBV未激活组的6.7%(P<0.05)。多因素logistic回归分析显示,肝Child-Pugh分级(OR=1.129,95%CI=1.004~1.270)、血清HBV DNA(OR=1.146,95%CI=1.028~1.278)是PLC患者精确放疗后HBV再激活的独立影响因素(P<0.05)。结论PLC患者精确放疗后HBV再激活与肝Child-Pugh分级、血清HBV DNA水平密切相关,临床应引起足够重视。Objective Objective to explore the influencing factors of reactivation of hepatitis B virus(HBV)after precise radiotherapy for primary liver cancer(PLC).Methods From May 2016 to may 2019,138 PLC patients in our hospital received precise radiotherapy.The tumor diameter,child-pugh grade of liver function,HBV DNA and other general data of patients were counted to analyze the occurrence of HBV reactivation after precise radiotherapy,and multivariate Logistic regression was used to analyze the independent influencing factors of HBV reactivation after precise radiotherapy in patients with PLC.Results All 138 PLC patients received precise radiotherapy,and 34(24.6%)had HBV reactivation,including 6(4.3%)at 4 weeks after precise radiotherapy,16(11.6%)at 8 weeks,and 12(8.7%)at 12 weeks,all of which were included in the HBV reactivation group;104 patients(75.4%)did not experience HBV reactivation and were included in the HBV inactive group.The proportion of child-pugh grade B in the HBV reactivation group was 58.8%,significantly higher than 14.4%in the non-activated group(P<0.05);The proportion of serum HBV DNA>1.0×104 copies/ml in the HBV reactivation group was 50.0%,significantly higher than 6.7%in the non-activated group(P<0.05).Multivariate Logistic regression analysis showed that child-pugh grade(OR=1.129,95%CI=1.004~1.270)and serum HBV DNA(OR=1.146,95%CI=1.028~1.278)were independent influencing factors for HBV reactivation in PLC patients after accurate radiotherapy(P<0.05).Conclusion The reactivation of HBV in PLC patients after precise radiotherapy is closely related to the child Pugh grade of liver and the level of HBV DNA in serum,which should be paid more attention in clinical practice.

关 键 词：精确放疗 原发性肝癌 乙型肝炎病毒再激活 HBV DNA 

分 类 号：R73[医药卫生—肿瘤]