摘要
目的探讨原发性肝癌（primary liver cancer,PLC）患者行肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）后对乙肝病毒（hepatitis B virus,HBV）再激活的影响因素。方法收集2014-10至2015-08,55例PLC患者,以性别、年龄、肿瘤大小、肝功能、肿瘤标志物甲胎蛋白（α-fetoprotein,AFP）、术前HBV脱氧核糖核酸（deoxyribonucleic acid,DNA）载量、门脉癌栓、术中碘油用量及操作方法（是否使用微导管超选择插管）等作为研究因素进行统计学分析。结果单因素分析结果显示：丙氨酸转氨酶（alanine aminotransferase,ALT）、总胆红素（total bilirubin,TBIL）、术前AFP值、术前HBV DNA高载量、碘油用量均对HBV的再激活有统计学意义（P≤0.05）;多因素分析结果显示：碘油用量≥10 ml是影响HBV再激活的最大危险因素[比值比（odd ratio,OR）=30.048,95%置信区间（confidence interval,CI）（3.438~262.625）]。结论 TACE可能引起PLC患者HBV再激活,这可能与碘油用量及术前HBV DNA高载量、高AFP等因素相关,故行TACE时应综合考虑各方面因素,适当使用碘油,积极检测HBV DNA载量并积极控制,以防止HBV再激活损害肝功影响患者预后。
Objective To explore the influencing factors of hepatitis B virus（HBV） reactivation in primary liver cancer（PLC） patients after transcatheter arterial chemoembolization（TACE）. Methods 55 cases of PLC during October 2014 to August 2015 were recruited. Took their gender, age, tumor size, liver function, tumor marker α-fetoprotein（AFP）, preoperative HBV DNA load, portal vein tumor thrombus, dosage of lipiodol and operation method（whether or not used micro catheter for super selective intubation） in operation, etc. as research factors and statistically analyzed. Results Single factor analysis results showed that alanine aminotransferase（ALT）, total bilirubin（TBIL）, preoperative AFP, preoperative HBV DNA high load, and dosage of lipiodol were all statistically significant for HBV reactivation（P ≤ 0.05）; Multiple factors analysis showed that dosage of lipiodol more than 10 ml was the greatest risk factor for HBV reactivation [odd ratio（OR）=30.048,95% confidence interval（CI）（3.438~262.625）]. Conclusions TACE may cause HBV reactivation in PLC patients, which may be related to dosage of lipiodol, HBV DNA high load and high AFP before operation, etc. Therefore, all aspects should be comprehensively considered before TACE operation, appropriately use of lipiodol, positively detect and control of HBV DNA load, to prevent liver function damage for HBV reactivation and affect patients＇ prognosis.
出处
《中华灾害救援医学》
2016年第1期25-28,共4页
Chinese Journal of Disaster Medicine
关键词
原发性肝癌
肝动脉化疗栓塞
乙肝病毒
再激活
primary liver cancer
transcatheter arterial chemoembolization
hepatitis B virus
reactivation
