Hiraoka Atsushi, Michitaka Kojiro, Kumagi Teru, Kurose Kiyotaka, Uehara Takahide, Hirooka Masashi, Yamashita Yoshimasa, Kubo Yoshikazu, Miyaoka Hiroaki, Iuchi Hidehito, Okada Shinichi, Ohmoto Masaki, Yamamoto Kazuhisa, Horiike Norio, Onji Morikazu
Third Department of Internal Medicine, Ehime University School of Medicine, Ehime 791-0295, Japan.
Oncol Rep. 2005 Jun;13(6):1159-63.
The prognosis for patients with decompensated hepatitis B virus (HBV) related liver cirrhosis (LC-B), especially for those with LC-B complicated with hepatocellular carcinoma (HCC), is poor. We investigated the effects of lamivudine in patients with decompensated LC-B, with and without HCC. Decompensated LC-B patients (n=55) with Child-Pugh classification scores (CPS) >7 points were enrolled. All were admitted to the hospitals of the authors between January 1997 and December 2004. Decompensated cases due to a severe exacerbation of hepatitis with CH-B and patients with HCC showing an extra hepatic metastasis or portal vein tumor thrombus were excluded. Some 19 cases (including 5 cases complicated with HCC at the start of therapy) were treated with lamivudine at 100 mg/day (L group), and 36 (including 7 cases with HCC at time of admittance) were treated without lamivudine (non-L group). The median of CPS points in the L group was higher than that of non-L group (11 points versus 9 points, p<0.02). Prothrombin time (%), albumin, ascites, CPS, and HBV-DNA quantity were each significantly improved after 6 months in the L group (p<0.05). A mutation in the YMDD motif was observed in 5 patients in the L group, however liver function did not deteriorate. Further, the survival rate was significantly higher in the L group (p<0.05). HCC was found in 3 L group and 4 non-L group patients during the study. In the L group, all patients complicated with HCC were treated repeatedly or until cured, whereas 91% of those in the non-L group could not be treated (p<0.01). Our results suggest that lamivudine is a useful and important therapy for patients with decompensated LC-B with and without HCC, as well as those who are restricted from having liver transplantation.
失代偿期乙型肝炎病毒（HBV）相关肝硬化（LC-B）患者，尤其是合并肝细胞癌（HCC）的LC-B患者，预后较差。我们研究了拉米夫定对伴有或不伴有HCC的失代偿期LC-B患者的影响。纳入Child-Pugh分级评分（CPS）>7分的失代偿期LC-B患者（n = 55例）。所有患者均于1997年1月至2004年12月期间入住作者所在医院。排除因慢性乙型肝炎严重恶化导致的失代偿病例以及出现肝外转移或门静脉肿瘤血栓的HCC患者。约19例患者（包括治疗开始时合并HCC的5例）接受拉米夫定治疗，剂量为100 mg/天（L组），36例患者（包括入院时合并HCC的7例）未接受拉米夫定治疗（非L组）。L组CPS评分中位数高于非L组（11分对9分，p<0.02）。L组患者在6个月后凝血酶原时间（%）、白蛋白、腹水、CPS和HBV-DNA量均有显著改善（p<0.05）。L组有5例患者观察到YMDD基序突变，但肝功能未恶化。此外，L组的生存率显著更高（p<0.05）。研究期间，L组有3例患者和非L组有4例患者发现HCC。在L组中，所有合并HCC的患者均接受了反复治疗或直至治愈，而非L组中91%的患者无法接受治疗（p<0.01）。我们的结果表明，拉米夫定对于伴有或不伴有HCC的失代偿期LC-B患者以及那些受限无法进行肝移植的患者是一种有用且重要的治疗方法。
