乙型肝炎相关肝细胞癌患者术后乙肝病毒再激活与手术诱导的免疫抑制
Postoperative hepatitis B virus reactivation and surgery-induced immunosuppression in patients with hepatitis B-related hepatocellular carcinoma.
作者信息
Xie Zhi-Bo, Zhu Shao-Liang, Peng Yu-Chong, Chen Jie, Wang Xiao-Bo, Ma Liang, Bai Tao, Xiang Bang-De, Li Le-Qun, Zhong Jian-Hong
机构信息
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China.
Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
J Surg Oncol. 2015 Nov;112(6):634-42. doi: 10.1002/jso.24044. Epub 2015 Sep 30.
BACKGROUND
Hepatectomy in hepatocellular carcinoma (HCC) patients lead to postoperative hepatitis B virus (HBV) reactivation (PHR) as well as immunosuppression.
METHODS
This prospective study involved 135 HBV-related HCC patients and 42 control hepatic hemangioma patients.
RESULTS
Among HCC patients, 26 (19.3%) suffered PHR. Risk factors for PHR were HBV-cAg S1 positivity [hazard ratio (HR) = 404.82, P = 0.004], high preoperative total bilirubin level (HR = 186.38, P = 0.036), small preoperative proportions of CD3-CD16 + CD56 + cells (HR = 0.01, P = 0.014) and CD19 + B cells (HR = 0.02, P = 0.016), blood transfusion (HR = 157.03, P = 0.006) and high liver cirrhosis S score (HR = 270.45, P = 0.004). On postoperative day (POD) 3, PHR patients showed much greater immunosuppression than non-PHR patients based on proportions of T cells (CD3+, CD3 + CD4+, CD3 + CD8+), B cells (CD19+) and on levels of IgG, IgA antibodies, complement proteins C3, and C4. By POD 7, PHR patients had partially recovered but not as quickly as non-PHR patients: PHR patients still showed deficits in T cells (CD3+, CD3 + CD4+), CD3-CD16 + CD56+ cells and in levels of IgM, C3, C4, and C-reactive protein.
CONCLUSION
PHR may be associated with resection-induced immunosuppression in patients with HBV-related HCC.
背景
肝细胞癌（HCC）患者行肝切除术后会导致术后乙型肝炎病毒（HBV）再激活（PHR）以及免疫抑制。
方法
这项前瞻性研究纳入了135例HBV相关的HCC患者和42例对照肝血管瘤患者。
结果
在HCC患者中，26例（19.3%）发生了PHR。PHR的危险因素包括HBV - cAg S1阳性[风险比（HR）= 404.82，P = 0.004]、术前总胆红素水平高（HR = 186.38，P = 0.036）、术前CD3 - CD16 + CD56 +细胞（HR = 0.01，P = 0.014）和CD19 + B细胞比例低（HR = 0.02，P = 0.016）、输血（HR = 157.03，P = 0.006）以及肝硬化S评分高（HR = 270.45，P = 0.004）。术后第3天（POD 3），基于T细胞（CD3 +、CD3 + CD4 +、CD3 + CD8 +）、B细胞（CD19 +）比例以及IgG、IgA抗体、补体蛋白C3和C4水平，PHR患者的免疫抑制程度比非PHR患者严重得多。到POD 7时，PHR患者部分恢复，但不如非PHR患者恢复快：PHR患者在T细胞（CD3 +、CD3 + CD4 +）、CD3 - CD16 + CD56 +细胞以及IgM、C3、C4和C反应蛋白水平方面仍存在不足。
结论
PHR可能与HBV相关HCC患者切除术后诱导的免疫抑制有关。
Zotero 插件