恩替卡韋抗病毒治療對HBV相關(guān)HCC根治性消融治療術(shù)后臨床轉(zhuǎn)歸的影響
發(fā)布時間：2018-07-13 14:02
【摘要】：目的:探討恩替卡韋抗病毒治療對乙型肝炎病毒相關(guān)肝細(xì)胞癌根治性消融治療術(shù)后臨床轉(zhuǎn)歸的影響。方法:回顧性研究天津市第二人民醫(yī)院自2011年1月至2014年2月期間收治的103例乙型肝炎病毒相關(guān)肝細(xì)胞癌患者,將患者按照抗病毒治療藥物不同分成2組,即根治性消融治療聯(lián)合拉米夫定抗病毒治療組(n=50)和根治性消融治療聯(lián)合恩替卡韋抗病毒治療組(n=53),消融治療后應(yīng)用抗病毒治療隨訪3年,觀察其治療前及治療期間ALT、AST、GGT、ALB、TBIL、BUN、CRE、PLT、PT、HBsAg、HBe Ag、高敏HBV-DNA、AFP的變化,觀察其腫瘤新生/復(fù)發(fā)的情況,隨訪患者治療期間并發(fā)癥發(fā)生情況,隨訪患者生存期,以評估恩替卡韋抗病毒治療對于乙型肝炎病毒相關(guān)肝細(xì)胞癌患者生存期及生存質(zhì)量的臨床轉(zhuǎn)歸及影響。結(jié)果:1.兩組患者治療前在ALT、AST、GGT、ALB、TBIL、BUN、CRE、PLT、PT、HBs Ag、HBeAg、高敏HBV-DNA、AFP、BCLC分期及腫瘤分化程度上均無顯著差異(P0.05)。2.對兩組患者在治療前、治療1個月、3個月、6個月、1年、2年及3年ALT、AST、GGT、ALB、TBIL、BUN、CRE、PLT、PT、HBsAg、HBeAg分別進行比較,各項指標(biāo)均無顯著性差異(P0.05)。3.分析兩組各時間段高敏HBV-DNA水平情況,兩組于抗病毒治療1月、3月及6月高敏HBV-DNA水平,經(jīng)統(tǒng)計學(xué)處理無意義(P0.05),治療1年、2年及3年兩組高敏HBV-DNA水平,經(jīng)統(tǒng)計學(xué)處理有意義(P=0.016,P=0.06,P=0.012)。4.對兩組患者在治療前、治療1個月、3個月、6個月、1年、2年及3年期間肝功能Child-Pugh評分進行比較,結(jié)果顯示兩組患者治療前、治療1個月、3個月、6個月期間肝功能Child-Pugh評分比較無顯著性差異(P0.05),在抗病毒治療1年以后,兩組患者Child-Pugh評分比較均有顯著性差異(P=0.03,P=0.011,P=0.021)。5.對兩組患者在治療1個月、3個月、6個月、1年、2年及3年期間腫瘤新生/復(fù)發(fā)情況進行比較,兩組患者抗病毒治療1個月、3個月、6個月期間腫瘤新生/復(fù)發(fā)情況比較無顯著性差異(P0.05),抗病毒治療1年、2年及3年,兩組患者腫瘤新生/復(fù)發(fā)情況比較,均有顯著性差異(P=0.024,P=0.038,P=0.019)。6.隨訪兩組患者治療期間并發(fā)癥發(fā)生情況,兩組患者在上消化道出血及肝癌結(jié)節(jié)破裂出血并發(fā)癥發(fā)生情況比較,有顯著性差異(P0.05)。而在其他并發(fā)癥發(fā)生情況比較,無顯著性差異(P0.05)。7.隨訪兩組患者生存期,兩組患者抗病毒治療6個月、1年、2年生存率比較,無顯著性差異(P0.05),抗病毒治療3年患者生存率比較,有顯著性差異(P0.05)。結(jié)論:對于乙型肝炎病毒相關(guān)肝細(xì)胞癌根治性消融治療術(shù)后患者,恩替卡韋抗病毒治療可將HBV復(fù)制抑制至較低水平,改善肝臟功能,減少終末期肝病事件的發(fā)生,提高生命質(zhì)量,降低腫瘤新生/復(fù)發(fā)風(fēng)險,獲得更高的生存率。
[Abstract]:Objective: to investigate the effect of entecavir antiviral therapy on the clinical outcome after radical ablation of hepatitis B virus associated hepatocellular carcinoma. Methods: 103 patients with hepatitis B virus associated hepatocellular carcinoma treated in Tianjin second people's Hospital from January 2011 to February 2014 were retrospectively studied. The patients were divided into two groups according to antiviral drugs. That is, radical ablation therapy combined with lamivudine antiviral therapy group (NN50) and radical ablation therapy combined with entecavir antiviral therapy group (NN53). The patients were followed up for 3 years with antiviral therapy after ablation. To observe the changes of HBe and Gao Min HBV-DNA Gao Min before and during the treatment, to observe the occurrence of complications during the follow-up, and to observe the survival time of the patients, and to observe the changes of HBe and HBV-DNA AFP before and during the treatment. To evaluate the clinical outcome and effect of entecavir antiviral therapy on survival and quality of life of patients with hepatitis B virus associated hepatocellular carcinoma. The result is 1: 1. Before treatment, there was no significant difference between the two groups in the levels of HBeAg, Gao Min HBV-DNA, AFP-BCLC staging and tumor differentiation (P0.05). Before treatment, the patients in the two groups were treated for 1 month, 3 months, 6 months, 1 year, 2 years and 3 years, respectively. There was no significant difference in all the indexes between the two groups (P0.05). The levels of Gao Min HBV-DNA in the two groups were analyzed in each time period. The levels of Gao Min HBV-DNA in the two groups were not statistically significant at 1 month, 3 months and 6 months after antiviral treatment (P0.05). The levels of Gao Min HBV-DNA in the two groups were statistically significant (P0.016, P0.06, P0.012) .4.The level of HBV-DNA in the two groups was significantly higher than that in the control group (P 0.016, P 0.06, P 0.012). Child-Pugh scores of liver function were compared between the two groups before treatment for 1 month, 3 months, 6 months, 1 year, 2 years and 3 years. There was no significant difference in Child-Pugh score between the two groups after 1 month, 3 months and 6 months of treatment (P0.05). After one year of antiviral therapy, there was significant difference in Child-Pugh score between the two groups (P < 0.05). A comparison was made between the two groups of tumor regeneration / recurrence during 1 month, 3 months, 6 months, 1 year, 2 years and 3 years of treatment. There was no significant difference in tumor regeneration / recurrence between the two groups during antiviral therapy for 1 month, 3 months and 6 months (P0.05), but there was significant difference between the two groups (P0.024, P0. 038, P0. 019) .6in antiviral therapy for 1 year, 2 years and 3 years, there was a significant difference between the two groups (P0. 024, P0. 038, P0. 019). Follow up the two groups of patients during the treatment of complications, the two groups in the upper gastrointestinal bleeding and liver cancer nodules rupture bleeding complications, there was significant difference (P0.05). However, there was no significant difference in the occurrence of other complications (P0.05). There was no significant difference in survival rate between the two groups after 6 months, 1 year and 2 years of antiviral therapy (P0.05), but there was a significant difference in the 3-year survival rate of the patients treated with antiviral therapy (P0.05). Conclusion: for patients with hepatitis B virus associated hepatocellular carcinoma after radical ablation therapy, entecavir antiviral therapy can inhibit HBV replication to a lower level, improve liver function and reduce the incidence of end-stage liver disease. Improve the quality of life, reduce the risk of tumor growth / recurrence, and achieve a higher survival rate.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62
本文編號：2119616
[Abstract]:Objective: to investigate the effect of entecavir antiviral therapy on the clinical outcome after radical ablation of hepatitis B virus associated hepatocellular carcinoma. Methods: 103 patients with hepatitis B virus associated hepatocellular carcinoma treated in Tianjin second people's Hospital from January 2011 to February 2014 were retrospectively studied. The patients were divided into two groups according to antiviral drugs. That is, radical ablation therapy combined with lamivudine antiviral therapy group (NN50) and radical ablation therapy combined with entecavir antiviral therapy group (NN53). The patients were followed up for 3 years with antiviral therapy after ablation. To observe the changes of HBe and Gao Min HBV-DNA Gao Min before and during the treatment, to observe the occurrence of complications during the follow-up, and to observe the survival time of the patients, and to observe the changes of HBe and HBV-DNA AFP before and during the treatment. To evaluate the clinical outcome and effect of entecavir antiviral therapy on survival and quality of life of patients with hepatitis B virus associated hepatocellular carcinoma. The result is 1: 1. Before treatment, there was no significant difference between the two groups in the levels of HBeAg, Gao Min HBV-DNA, AFP-BCLC staging and tumor differentiation (P0.05). Before treatment, the patients in the two groups were treated for 1 month, 3 months, 6 months, 1 year, 2 years and 3 years, respectively. There was no significant difference in all the indexes between the two groups (P0.05). The levels of Gao Min HBV-DNA in the two groups were analyzed in each time period. The levels of Gao Min HBV-DNA in the two groups were not statistically significant at 1 month, 3 months and 6 months after antiviral treatment (P0.05). The levels of Gao Min HBV-DNA in the two groups were statistically significant (P0.016, P0.06, P0.012) .4.The level of HBV-DNA in the two groups was significantly higher than that in the control group (P 0.016, P 0.06, P 0.012). Child-Pugh scores of liver function were compared between the two groups before treatment for 1 month, 3 months, 6 months, 1 year, 2 years and 3 years. There was no significant difference in Child-Pugh score between the two groups after 1 month, 3 months and 6 months of treatment (P0.05). After one year of antiviral therapy, there was significant difference in Child-Pugh score between the two groups (P < 0.05). A comparison was made between the two groups of tumor regeneration / recurrence during 1 month, 3 months, 6 months, 1 year, 2 years and 3 years of treatment. There was no significant difference in tumor regeneration / recurrence between the two groups during antiviral therapy for 1 month, 3 months and 6 months (P0.05), but there was significant difference between the two groups (P0.024, P0. 038, P0. 019) .6in antiviral therapy for 1 year, 2 years and 3 years, there was a significant difference between the two groups (P0. 024, P0. 038, P0. 019). Follow up the two groups of patients during the treatment of complications, the two groups in the upper gastrointestinal bleeding and liver cancer nodules rupture bleeding complications, there was significant difference (P0.05). However, there was no significant difference in the occurrence of other complications (P0.05). There was no significant difference in survival rate between the two groups after 6 months, 1 year and 2 years of antiviral therapy (P0.05), but there was a significant difference in the 3-year survival rate of the patients treated with antiviral therapy (P0.05). Conclusion: for patients with hepatitis B virus associated hepatocellular carcinoma after radical ablation therapy, entecavir antiviral therapy can inhibit HBV replication to a lower level, improve liver function and reduce the incidence of end-stage liver disease. Improve the quality of life, reduce the risk of tumor growth / recurrence, and achieve a higher survival rate.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62
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