Witjes C D M, IJzermans J N M, van der Eijk A A, Hansen B E, Verhoef C, de Man R A
Department of Hepatobiliary and Transplantation Surgery, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
Neth J Med. 2011 Nov-Dec;69(11):508-13.
Hepatitis B virus infection (HBV) is an important co-factor in the development of hepatocellular carcinoma (HCC). We studied whether quantitative HBV DNA at time of HCC detection influences survival of HCC patients. All diagnosed HCC cases between 2000 and 2008 at our university-based reference centre were analysed to determine the influence of hepatitis B viral load on overall survival. Clinical and virological findings were evaluated in univariate and multivariate analyses, survival rates were assessed for HCC patients with a high viral load (HBV DNA ≥10(5) copies/ml) and low viral load (HBV DNA <10(5) copies/ml). HCC was diagnosed in 597 patients, including 98 patients with HBV. The group of 37 patients (38%) who had a high viral load contained more HBeAg-positive patients, had lower serum albumin levels and higher serum aspartate aminotransferase (AST ) and alanine aminotransferase (ALT ) levels. The one- and five-year survival rates of HCC patients with a high viral load were 58% and 11% and for HCC patients with a low viral load 70% and 35%, respectively. In multivariate analysis a higher AST level and higher viral load were significantly associated with shorter overall survival (HR=2.30; p=0.018, HR=1.22; p=0.015, respectively). HBeAg positivity, low albumin level or high AST or ALT levels in HCC patients are associated with a higher HBV DNA . HBV DNA level at detection is associated with overall survival of HCC patients. These findings support the concept that after HCC detection adequate suppression of HBV DNA by nucleoside analogue therapy may improve survival.
乙型肝炎病毒感染（HBV）是肝细胞癌（HCC）发生发展的一个重要协同因素。我们研究了HCC检测时的HBV DNA定量是否会影响HCC患者的生存。对2000年至2008年在我们大学附属医院参考中心确诊的所有HCC病例进行分析，以确定乙肝病毒载量对总生存的影响。在单因素和多因素分析中评估临床和病毒学结果，对高病毒载量（HBV DNA≥10⁵拷贝/ml）和低病毒载量（HBV DNA＜10⁵拷贝/ml）的HCC患者的生存率进行评估。597例患者被诊断为HCC，其中98例为HBV感染患者。高病毒载量的37例患者（38%）中HBeAg阳性患者更多，血清白蛋白水平更低，血清天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平更高。高病毒载量的HCC患者1年和5年生存率分别为58%和11%，低病毒载量的HCC患者分别为70%和35%。在多因素分析中，较高的AST水平和较高的病毒载量与较短的总生存显著相关（风险比分别为2.30，P = 0.018；风险比为1.22，P = 0.015）。HCC患者中HBeAg阳性、低白蛋白水平或高AST或ALT水平与较高的HBV DNA相关。检测时的HBV DNA水平与HCC患者的总生存相关。这些发现支持这样一个概念，即HCC检测后通过核苷类似物治疗充分抑制HBV DNA可能会改善生存。
