Department of Hepatobilliary Oncology, Sun Yat-sen University Cancer Center and State Key Laboratory of Southern China, Guangzhou, China Department of Surgical Oncology of University of Michigan University of Michigan, Ann Arbor, Michigan, USA.
Hepatol Res. 2011 Jun;41(6):553-63. doi: 10.1111/j.1872-034X.2011.00796.x. Epub 2011 Mar 29.
Reports concerning changes in hepatitis B virus (HBV) status and liver function in hepatocellular carcinoma (HCC) during or after transcatheter arterial chemoembolization (TACE) have been rare and the results inconsistent. The objective of this retrospective study was to evaluate these parameters in a large cohort of HBV-related HCC patients.
One hundred and seventy-two hepatitis B surface antigen positive HCC patients with Child-Pugh grade A or B liver disease who underwent 228 sessions of TACE were enrolled, and related clinical and laboratory data were analyzed.
In total, HBV reactivated in 33 (14.5%), remained stable in 152 (66.7%) and decreased in 43 (18.8%) sessions. Univariate analysis revealed that sex and HBV DNA levels correlated with changes in HBV DNA status after TACE, while hepatitis B e-antigen (HBeAg), prothrombin time and chemotherapeutic agents were marginally significant factors. Multivariate analysis demonstrated that the major factors that influenced the HBV DNA status were baseline HBV DNA levels(P = 0.0002) and HBeAg (P = 0.0387). A comparison of the post-TACE (30-90 days) liver function to the baseline revealed no significant differences. The reactivation group has the highest rate of exacerbation (12.1%) compared with the stable group (5.9%) and downregulation group (4.7%).
HBV DNA changes after TACE included reactivated, decreased and stable HBV DNA levels. Although HBV reactivation did not necessarily result in exacerbation of liver damage and most HCC patients with Child-Pugh grade A and B tolerated TACE well, careful post-procedure monitoring and managing is needed.
关于经导管动脉化疗栓塞（TACE）过程中或之后乙型肝炎病毒（HBV）状态和肝功能变化的报道很少，结果也不一致。本回顾性研究的目的是评估大量乙型肝炎相关 HCC 患者的这些参数。
共纳入 172 例乙型肝炎表面抗原阳性、Child-Pugh 分级为 A 或 B 的 HCC 患者，共进行了 228 次 TACE 治疗，分析了相关的临床和实验室数据。
共有 33 次（14.5%）HBV 再激活，152 次（66.7%）HBV 稳定，43 次（18.8%）HBV 下降。单因素分析显示，性别和 HBV DNA 水平与 TACE 后 HBV DNA 状态变化相关，而 HBeAg、凝血酶原时间和化疗药物为边缘显著因素。多因素分析表明，影响 HBV DNA 状态的主要因素是基线 HBV DNA 水平（P=0.0002）和 HBeAg（P=0.0387）。与基线相比，TACE 后（30-90 天）肝功能无显著差异。与稳定组（5.9%）和下调组（4.7%）相比，再激活组的肝损伤加重率最高（12.1%）。
TACE 后 HBV DNA 变化包括再激活、下降和稳定的 HBV DNA 水平。虽然 HBV 再激活不一定导致肝损伤加重，大多数 Child-Pugh 分级为 A 和 B 的 HCC 患者能很好地耐受 TACE，但需要术后密切监测和管理。
