恩替卡韦联合介入治疗乙型肝炎相关原发性肝癌的临床研究
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郭锰, Email: mfyx120@163.com

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河南省南阳市科技攻关计划资助项目(2012GG088)。


Clinical efficacy of combined entecavir and interventional therapy in treatment of hepatitis B virus-related hepatocellular carcinoma
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    摘要:

    目的:探讨恩替卡韦联合介入方法治疗乙型肝炎相关原发性肝癌(HBVR-HCC)的临床疗效。 方法:选择2007年2月—2011年2月85例确诊为HBVR-HCC、没有手术治疗适应证的患者,其中44例采用恩替卡韦联合肝动脉段性化疗栓塞(TACE)治疗(观察组),41例单纯采用TACE治疗(对照组),分析两组治疗前和治疗后4、12、24、48周HBV-DNA水平、肝功能、AFP水平和Child-Pugh评分,并比较两组的临床疗效、不良反应以及生存状况。 结果:随治疗时间延长,观察组HBV-DNA水平逐渐降低,而对照组逐渐升高,两组差异在治疗后各时间点均有统计学意义(均P<0.05);两组谷丙转氨酶(ALT)与AFP水平、逐渐降低,但观察组在治疗24周后的降低程度明显优于对照组(均P<0.05);两组Child-Pugh评分逐渐升高,但观察组在治疗24周后的升高程度低于对照组(P<0.05)。观察组HCC的治疗有效率明显高于对照组,并发症和不良反应均明显低于对照组(均P<0.05)。两组的1年生存率的差异无统计学意义(P>0.05),但观察组2年生存率和中位生存期优于对照组(均P<0.05)。 结论:TACE对HBV活动存在激发作用,抗病毒联合TACE治疗HBVR-HCC可有效控制HBV,改善患者的肝功能,提高临床疗效,且不增加毒副作用。

    Abstract:

    Objective: To investigate the clinical efficacy of the combination of entecavir and interventional therapy in treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HBVR-HCC). Methods: From February 2007 to February 2011, 85 patients definitely diagnosed as HBVR-HCC and without indication for surgery were selected. Of the patients, 44 cases underwent entecavir plus transarterial chemoembolization (TACE) treatment (observational group), and 41 cases received TACE alone (control group). The HBV DNA level, liver function, AFP level, and Child-Pugh score of the two groups before treatment and at 4, 12, 24, and 48 weeks after treatment were analyzed, and the clinical efficacy, incidence of adverse effects, and survival status between the two groups were compared. Results: With prolongation of treatment time, the HBV-DNA level in observational group was gradually decreased, while in control group it was gradually increased, and the differences at each time point after treatment between the two groups had statistical significance (P<0.05); the alanine transaminase (ALT) and AFP levels were gradually decreased, but their decreasing degrees were greater than those in control group after 24-week treatment (all P<0.05); the Child-Pugh scores in both groups were gradually increased but the increasing degree in observational group was significantly lower than that in control group after 24-week treatment (P<0.05). The effective rate of treatment in observational group was significantly higher, while the incidence of complications and adverse reactions in observational group was significantly lower than those in control group (all P<0.05). No statistical difference was noted in 1-year survival rate between the two groups (P>0.05), but the 2-year survival rate and median survival time in observational group were better than those in control group (both P<0.05). Conclusion: TACE may motivate the activity of HBV replication, and the combination of antiviral and TACE treatment for HBVR-HCC can effectively control HBV replication, and improve liver function without increase of side effects.

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郭锰.恩替卡韦联合介入治疗乙型肝炎相关原发性肝癌的临床研究[J].中国普通外科杂志,2014,23(7):898-903.
DOI:10.7659/j. issn.1005-6947.2014.07.007

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  • 收稿日期:2014-01-15
  • 最后修改日期:2014-06-07
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  • 在线发布日期: 2014-07-20