2015 年第 2 期 第 13 卷

原发性肝癌三维适形放疗致乙型肝炎病毒再激活相关研究

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关键词：肝癌三维适形放疗乙型肝炎病毒再激活影响因素放射性肝损伤

• 摘要：
• 【摘要】目的 探讨原发性肝癌三维适形放疗(3D-CRT）致乙型肝炎病毒（HBV）再激活的相关因素。方法 选择2010年1月至2012年12月期间56例接受3D-CRT治疗的原发性肝癌患者为研究对象。将56例患者按3D-CRT治疗后是否接受抗病毒治疗分为两组。A组（抗病毒治疗组）：32例；B组（未抗病毒治疗）：24例。统计HBV再激活率、HBV再激活危险因素、HBV再激活相关性肝炎、ALT升高情况、肝功能损伤程度、RILD发生率及转归。结果 3D-CRT治疗后12周A组总的HBV再激活率低于B组，有统计学意义（P<0.05）；HBV再激活组和HBV未激活组Child-Pugh分级构成、HBV DNA水平比较差异具有统计学意义（P<0.05）；两组ALT升高2倍的病例比例无统计学差异（P>0.05），A组再激活相关性肝炎发生率（6.25%）低于B组（25.0%），有统计学意义（P<0.05），A组和B组肝功能损伤程度无统计学差异（P>0.05）；A组（6.25%）和B组（16.67%）RILD发生率比较无统计学意义（χ2=1.5556,P=0.2123, P>0.05）。结论 3D-CRT技术是中晚期肝癌治疗的重要方案，HBV再激活及RILD是肝癌3D-CRT治疗时较为常见的并发症，应引起临床医师的足够重视；3D-CRT治疗后抗病毒治疗可以降低HBV再激活率及HBV再激活相关性肝炎的发生率。
• Objective To explore the related factors of primary hepatic carcinoma with three dimensional conformal radiotherapy induced reactivation of hepatitis B virus. Methods From January 2010 to December 2010, 56 patients with primary liver cancer for 3 D-CRT therapy were selected as the research objects. The 56 patients， according to whether to accept the 3 D-CRT antiviral treatment were divided into two groups. Group A (antiviral treatment group): 32 cases; Group B (without antiviral treatment): 24 cases. Statistical analysis was carried out, including HBV reactivation rate and risk factors for HBV reactivation, HBV hepatitis reactivation correlation, elevated ALT and liver function damage degree, and the incidence of RILD. Results In the 12th week after 3 D-CRT treatment, total HBV reactivation rate of group A is lower than that of group B, with statistically significance (P < 0.05); For the two groups of HBV reactivation and inactivation, Child - Pugh, hierarchical structure and HBV DNA level have statistically significant difference (P < 0.05). The proportion of cases with elevated ALT 2 times has no statistical difference (P > 0.05). For group A, the incidence of reactivation correlation hepatitis (6.25%) is lower than group B (25.0%), with statistical significance (P < 0.05). For group A and group B liver function damage degree has no statistical difference (P > 0.05). The incidence of RILD has no statistical significance for group A (6.25%) and group B (16.67%) (χ2=1.5556, P=1.5556). Conclusions 3 D-CRT technology is an important solution of late-stage liver cancer treatment, but HBV reactivation and RILD are common complications after 3 D-CRT treatment, which should be paid more attention by the clinicians; Antiviral treatment can reduce the HBV reactivation rate and the incidence of HBV reactivation correlation hepatitis after 3 D-CRT treatment.