CAJ | 학술논문

目的探讨原发性肝癌(PLC)患者精确放疗后乙型肝炎病毒(HBV)再激活的临床特点,并分析其危险因素.方法回顾分析69例HBsAg阳性PLC患者行精确放疗并发HBV再激活的临床特点.所有患者放疗前均做基线血常规、肝功能、肾功能、甲胎蛋白、HBV标志物、HBV DNA定量测定.放疗中及后血常规检查每2周检测1次,肝功能、甲胎蛋白、HBV标志物、HBV DNA定量测定每4周检测1次,持续至放疗完成后至少12周.Logistic法评估临床各项指标对HBV再激活的影响.结果 69例中发生放射性肝病12例(17％),HBV再激活发生17例(25％),HBV再激活相关肝炎发生15例(22％).Logistic法评估结果显示基线血清HBV DNA水平为HBV再激活发生的危险因素.结论 PLC患者精确放疗后可引起HBV再激活,基线血清HBV DNA水平为其独立危险因素.发生HBV再激活相关肝炎患者即使及时采用抗病毒治疗预后仍不良.
목적 탐토원발성간암(PLC)환자정학방료후을형간염병독(HBV)재격활적림상특점,병분석기위험인소.방법 회고분석69례HBsAg양성PLC환자행정학방료병발HBV재격활적림상특점.소유환자방료전균주기선혈상규、간공능、신공능、갑태단백、HBV표지물、HBV DNA정량측정.방료중급후혈상규검사매2주검측1차,간공능、갑태단백、HBV표지물、HBV DNA정량측정매4주검측1차,지속지방료완성후지소12주.Logistic법평고림상각항지표대HBV재격활적영향.결과 69례중발생방사성간병12례(17％),HBV재격활발생17례(25％),HBV재격활상관간염발생15례(22％).Logistic법평고결과현시기선혈청HBV DNA수평위HBV재격활발생적위험인소.결론 PLC환자정학방료후가인기HBV재격활,기선혈청HBV DNA수평위기독립위험인소.발생HBV재격활상관간염환자즉사급시채용항병독치료예후잉불량.
Objective To investigate the clinical features of hepatitis B virus (HBV) reactivation after precise radiotherapy in patients with primary liver cancer (PLC) and analyze the risk factors for HBV reactivation.Methods A retrospective analysis was performed on the clinical data of 69 hepatitis B surface antigen (HBsAg)-positive patients with PLC,some of whom had HBV reactivation after precise radiotherapy.Before radiotherapy,all patients underwent baseline examinations,including blood routine,liver function test,renal function test,and quantifications of serum alpha-fetoprotein (AFP),serum HBV markers,and serum HBV DNA.During radiotherapy and within 12 weeks after radiotherapy,blood routine was performed biweekly,and liver function test,renal function test,and quantifications of serum AFP,serum HBV markers,and serum HBV DNA were performed once every four weeks.Logistic regression analysis was used to evaluate the association of the indices with HBV reactivation.Results Of the 69 patients,12 (17％) had radiation-induced liver disease,17 (25 ％) had HBV reactivation,and 15 (22％)developed hepatitis due to HBV reactivation.The logistic regression analysis showed that baseline serum HBV DNA level was the risk factor for HBV reactivation after precise radiotherapy.Conclusions HBV reactivation may occur after precise radiotherapy in patients with PLC,and baseline serum HBV DNA level is the independent risk factor for HBV reactivation.The patients who develop hepatitis due to HBV reactivation have poor prognosis even if they receive antiviral therapy in time.