PEI联合抗病毒药物治疗HBV-DNA阳性原发性肝癌的临床研究(1)
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[摘要] 目的：观察经皮无水酒精注射联合恩替卡韦治疗HBV-DNA阳性原发性肝癌患者的疗效。方法：60例HBV-DNA阳性原发性肝癌患者，随机分为两组，每组各30例。均给予PEI治疗。治疗组在常规保肝治疗基础上加用恩替卡韦，0.5 mg/d；对照组常规保肝治疗。结果：PEI治疗3个月后，对照组病灶完全坏死率明显低于治疗组(P<0.05)。对照组肿瘤复发率明显高于治疗组(P<0.05)。对照组1年生存率明显低于治疗组(P<0.05)。治疗组HBV-DNA转阴率高于对照组(P=0.000)。结论：PEI联合恩替卡韦治疗HBV-DNA阳性原发性肝癌患者疗效良好，能有效改善患者的预后。
[关键词] 经皮无水酒精注射 恩替卡韦 原发性肝癌 预后
[中图分类号] R735.7[文献标识码]A [文章编号]1673-7210(2011)02(c)-045-02
Clinical study of PEI with Antiviral treatment for primary liver cancer with HBV-DNA positive
WANG Dongsheng, WANG Chenggang, LU Ying, LIU Ming, LIU Haiyang
(Department of Intervention,Coal General Hospital, Beijing City,Beijng100028, China)
[Abstract] Objective: To study the therapeutic efficacy of PEI with Entecavir for the patients with primary liver cancer with HBV-DNA positive. Methods: 60 patients were devided into the treamtment group and the control group, they were treated by PEI. The treamtment group was treated by Entecavir. The control group was treamted by general remedy. Results: Three months later, the complete necrosis rate and recurrence rate were significantly difference in the treamtment group compared with the control group(P<0.05). The one year survival rate of the control group was lower than that in the treamtment group(P<0.05). The negative conversion ratio of HBV-NDA was reduced in the control group compared with the treamtment(P=0.000). Conclusion: The therapeutic efficacy of PEI with Entecavir for patients with primary liver cancer with HBV-DNA positive is satisfied, that can improve prognosis of the patients with primary liver cancer after PEI.
[Key words] Percutaneous ethanol injection; Entecavir; Primary liver cancer; Prognosis
原发性肝癌是世界上常见的恶性肿瘤之一，每年约有60万人死于该病[1]。目前，局部消融治疗已成为原发性肝癌常用治疗手段。经皮无水酒精注射(percutaneous ethanol injection, PEI)是直接将无水酒精注入肿瘤内，使肿瘤细胞变性坏死、肿瘤周围血管完全闭塞，进而导致肿瘤组织缺血坏死的一项技术。然而，在我国原发性肝癌患者多合并病毒性肝炎及肝炎后肝硬化。目前研究表明，HBV-DNA水平与肝细胞癌的发展水平相关[2]。因此在HBV-DNA阳性原发性肝癌患者行PEI治疗同时，联合应用抗乙肝病毒药物治疗对患者预后具有重要意义。恩替卡韦作为新一代核苷类抗病毒药物，在临床抗病毒治疗中应用广泛。我科2009年1月~2010年5月应用PEI联合恩替卡韦治疗HBV-DNA阳性原发性肝癌患者，取得良好临床疗效，现报道如下：
1 资料与方法
1.1 一般资料
HBV-DNA阳性原发性肝癌患者60例，随机分为治疗组、对照组，每组各30例。治疗组中，男20例，女10例。年龄36~72岁，平均年龄(58.73±11.38)岁；对照组中，男22例，女8例，年龄37~74岁，平均年龄(61.37±12.56)岁。治疗组中，肝功能A级7例，B级23例；对照组中，肝功能A级9例，B级21例。所有病例均经AFP、腹部CT或磁共振等确定诊断。HBV-DNA含量均≥104 copy/ml ......
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