肝脏 ›› 2018, Vol. 23 ›› Issue (4): 294-296.

• 论著 • 上一篇    下一篇

核苷(酸)类似物抗病毒治疗对乙型肝炎相关肝细胞癌患者预后的影响

安宝燕, 王云, 项小刚, 陈利文, 曹竹君, 闫蕾, 丁叶舟, 汤伟亮, 林兰意, 朱传武, 谢青, 王晖   

  1. 200025 上海交通大学医学院附属瑞金医院感染科(安宝燕,王云,项小刚,陈利文,曹竹君,闫蕾,丁叶舟,汤伟亮,林兰意,谢青,王晖);苏州第五人民医院感染科(朱传武)
  • 发布日期:2020-05-22
  • 通讯作者: 王晖,Email: wanghuirj@163.com
  • 基金资助:
    国家自然科学基金(81570560);上海市科学技术委员会科技支撑项目(16411960300);上海市公共卫生三年行动计划重点学科建设项目传染病与卫生微生物学(15GWZK0102);苏州市临床医学专家团队项目(SZYJTD201717)

The effects of nucleos(t)ide analogues treatment on prognosis of patients with chronic hepatitis B-related hepatocellular carcinoma

AN Bao-yan, WANG Yun, XIANG Xiao-gang, CHEN Li-wen, CAO Zhu-jun, YAN Lei, DING Ye-zhou, TANG Wei-liang, LIN Lan-yi, ZHU Chuan-wu, XIE Qing, WANG Hui   

  1. Department of Infectious Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Published:2020-05-22
  • Contact: WANG Hui, Email: wanghuirj@163.com

摘要: 目的 探讨核苷(酸)类似物(NA)抗病毒治疗对于乙型肝炎相关性肝细胞癌(HCC)患者预后的影响。方法 筛选2008 年1月至2015年11月在上海瑞金医院确诊和治疗的HCC患者532例,收集入组患者的基线特征,记录入组的乙型肝炎相关性HCC患者NA治疗的信息。将乙型肝炎相关性HCC患者分为持续 NA治疗组、HCC治疗后NA治疗组,NA未治组,对3组患者预后情况进行分析比较。结果 NA未治组患者的血清AFP水平为223.3 ng/mL,NA治疗组患者血清AFP水平为64.77 ng/mL(P<0.01);NA未治组患者的血清ALT水平为44 U/L,血清AST水平为54 U/L,NA治疗组患者血清ALT水平为32 U/L,血清AST水平为35 U/L(P<0.01);NA未治组患者的血清直接胆红素水平为5.4 μmol/L,NA治疗组患者血清直接胆红素水平为4 μmol/L(P<0.05)。NA治疗组乙型肝炎相关性HCC患者的HCC分期处于A期和B期所占比例(72.03%)显著高于NA未治组患者(46.38%)。持续NA治疗能够显著延长乙型肝炎相关性HCC患者的生存时间(P<0.01)。结论 NA治疗能够降低乙型肝炎相关性HCC患者的疾病严重程度,并有效延长患者的生存时间。

关键词: 核苷(酸)类似物, 肝细胞癌, 预后

Abstract: Objective To investigate effect of nucleos(t)ide analogues (NA) treatment on prognosis of patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Methods A total of 532 patients with CHB-related HCC in Shanghai Ruijin Hospital from January 2008 to November 2015 were retrospectively analyzed, whose baseline characteristics, NA treatment condition, Barcelona Clinic Liver Cancer (BCLC) scores and liver function were recorded. Patients were divided into three groups, including sustained NA treatment group, post-HCC NA treatment group and NA treatment-naïve group. Prognosis of the three groups was analyzed and compared. Results In NA treatment-naïve group, average levels of serum alpha fetoprotein, alanine aminotransferase, aspartate aminotransferase and direct bilirubin were 3.4-fold (223.3 ng/mL vs. 64.77 ng/mL, P<0.01), 1.4-fold (44 U/L vs. 32 U/L, P<0.01), 1.5-fold (54 U/L vs. 35 U/L, P<0.01) and 1.4-fold (5.4 ng/mL vs. 4 ng/mL, P<0.05) of those in NA treatment group, respectively. According to the BCLC staging system, proportion of patients with stage A or B in NA treatment group (72.03%) was higher than that in NA treatment-naïve group (46.38%). During the follow-up, survival in sustained NA treatment group was significantly longer than that in post-HCC NA treatment group or NA treatment-naïve group (P<0.05). Conclusion NA treatment for CHB-related HCC patients may alleviate disease severity and prolong life survival.

Key words: Nucleos(t)ide analogues, Hepatocellular carcinoma, Prognosis