肝癌乙型肝炎病毒感染患者术后恩替卡韦抗病毒治疗的临床疗效及安全性评价

目的:探讨肝癌乙型肝炎病毒(HBV)感染患者根治性切除术后采用恩替卡韦抗病毒治疗的临床疗效及安全性。方法:收集2015年1月-2017年8月在我院行根治性切除术的肝癌HBV感染患者279例为研究对象,以血清HBV-DNA载量10~5 copies/ml为界限,分为高病毒复制组128例,低病毒复制组151例,按照随机数字表法将高病毒复制组分为高-治疗组64例、高-对照组64例,将低病毒复制组分为低-治疗组76例、低-对照组75例。高-治疗组和低-治疗组术后给予恩替卡韦0.5 mg/d,高-对照组和低-对照组未行抗病毒治疗。比较手术前、术后7 d各组的血清HBV-DNA水平,血清白蛋白(ALB)、谷丙转氨酶(ALT)、前白蛋白(PA),以及术后并发症的发生情况。结果:高-治疗组、高-对照组、低-治疗组、低-对照组术后血清ALB、PA均较治疗前降低,血清ALT均较治疗前升高,且高-治疗组或低-治疗组术后血清ALB、PA均高于高-对照组或低-对照组,血清ALT水平均低于高-对照组或低-对照组,差异均有统计学意义(P0.05);高-治疗组或低-治疗组术后血清HBV-DNA水平均低于治疗前,且均低于同期高-对照组或低-对照组,差异均有统计学意义(P0.05)。高-治疗组与高-对照组、低-治疗组与低-对照组患者术后并发症发生率均无统计学差异(P0.05)。结论:恩替卡韦能显著改善肝癌HBV感染患者术后的血清HBV-DNA载量水平和肝功能,安全性高,值得临床推广。

Evaluation of Clinical Efficacy and Safety of Entecavir Antiviral Therapy in Postoperative Liver Carcinoma Patients with Hepatitis B Virus Infection

ABSTRACT Objective: To explore the clinical efficacy and safety of entecavir antiviral therapy in the treatment of liver carcinoma patients with hepatitis B virus(HBV)infection after radical resection. Methods: A total of 279 liver carcinoma patients with HBV infec- tion, who underwent radical resection surgery in General Hospital of Pangang Group from January 2015 to August 2017, were selected as subjects and were divided into high viral replication group(n=128) and low viral replication group(n=151) according to the demarcation line of 105 copies/mL of serum HBV-DNA loading. The high virus replicating group was further divided into high treatment group(n=64) and high control group(n=64); the low virus replication group was further divided into low treatment group(n=76) and low control group (n=75) according to the random number table methods. The high treatment group and low treatment group were treated with entecavir 0.5 mg/d after surgery, but high control group and low control group were not treated with entecavir. The serum HBV-DNA level, serum al- bumin (ALB), alanine aminotransferase (ALT), prealbumin (PA) levels before surgery and 7 d after surgery were compared; the incidence rate of complications after surgery in each group were also compared. Results: The serum ALB, PA levels after surgery were lower than before surgery, and serum ALT was higher than before surgery in high treatment group, high control group, low treatment group, and low control group. The serum ALB, PA levels after surgery in high treatment group or low-treatment group were higher than high control group or low control group, and serum ALT level after surgery were lower than high control group or low control group, the differences were statistically significant(P<0.05). The serum HBV-DNA level after surgery in high treatment group or low treatment group were lower than before surgery, and lower than high control group or low control group in the same period, the differences were statistically signifi- cant(P<0.05). There was no significant difference in postoperative incidence rate of complications among high treatment group, high con- trol group, low treatment group and low control group(P>0.05). Conclusion: Entecavir can significantly improve the serum HBV-DNA level and liver function of postoperative liver carcinoma patients with HBV infection, with highly safety, which is worthy of clinical pro- motion.