Wang Kai, Jiang Guomin, Jia Zhongzhi, Zhu Xiaoli, Ni Caifang
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou Department of Interventional Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.
Medicine (Baltimore). 2018 Jun;97(22):e10940. doi: 10.1097/MD.0000000000010940.
The aim of this study was to investigate the reactivation of the hepatitis B virus (HBV) following transarterial chemoembolization (TACE) in primary hepatocellular carcinoma (HCC) patients with HBV-DNA negative and to evaluate the effects of TACE combined with antiviral therapy.
This prospective study involved 98 patients with HBV-related and HBV-DNA negative HCC (HBV DNA < 10 copies/mL) underwent TACE procedures with serial HBV DNA tests. Patients were divided into the antiviral treatment group and the no-antiviral group. The antiviral group received entecavir antiviral therapy, and the other group received no antiviral therapy. Two groups of patients were compared in rate of HBV reactivation and liver function before and after only 1 session of TACE in average 1-month follow-up after operation. P < .05 indicated differences with a statistical significance.
HBV reactivation occurred in 11 patients in the nonantiviral group (11/47, 23.4%) but only 3 patients in the antiviral group (3/51, 5.9%, P < .05). On multivariate analysis, HBeAg-positive status, number of tumors more than 3, and absence of antiviral therapy were the independent risk predictor of HBV reactivation. Liver function indicators did not differ significantly between the antiviral group and the nonantiviral group in 5 days after TACE. However, the level of alanine aminotransferase and bilirubin were raised and albumin was reduced at the HBV reactivation group compared with no HBV reactivation group (P < .05). At 1 month after TACE, liver function indicators did not differ significantly between the HBV reactivation group and without HBV reactivation group.
HCC patients with HBV DNA negative still remain associated with risk of HBV reactivation after TACE. HBeAg-positive, number of tumors more than 3, and absence of antiviral therapy in HCC patients after TACE have a higher risk of HBV reactivation. Antiviral therapy can reduce the risk of reactivation, helping improve liver function after TACE.
本研究旨在调查乙肝病毒（HBV）DNA阴性的原发性肝细胞癌（HCC）患者经动脉化疗栓塞术（TACE）后乙肝病毒的再激活情况，并评估TACE联合抗病毒治疗的效果。
这项前瞻性研究纳入了98例HBV相关且HBV-DNA阴性的HCC患者（HBV DNA＜10拷贝/mL），这些患者接受了TACE手术并进行了系列HBV DNA检测。患者被分为抗病毒治疗组和非抗病毒组。抗病毒组接受恩替卡韦抗病毒治疗，另一组未接受抗病毒治疗。在术后平均1个月的随访中，比较两组患者仅进行1次TACE前后的HBV再激活率和肝功能。P＜0.05表示差异具有统计学意义。
非抗病毒组有11例患者发生HBV再激活（11/47，23.4%），而抗病毒组仅有3例（3/51，5.9%，P＜0.05）。多因素分析显示，HBeAg阳性状态、肿瘤数量超过3个以及未进行抗病毒治疗是HBV再激活的独立风险预测因素。TACE术后5天，抗病毒组和非抗病毒组的肝功能指标无显著差异。然而，与未发生HBV再激活组相比，HBV再激活组的谷丙转氨酶和胆红素水平升高，白蛋白水平降低（P＜0.05）。TACE术后1个月，HBV再激活组和未发生HBV再激活组的肝功能指标无显著差异。
HBV DNA阴性的HCC患者在TACE术后仍有HBV再激活的风险。TACE术后HBeAg阳性、肿瘤数量超过3个以及未进行抗病毒治疗的HCC患者HBV再激活风险较高。抗病毒治疗可降低再激活风险，有助于改善TACE术后的肝功能。
