CAJ | 학술논문

目的：探讨口服核苷（酸）类似物抗乙型肝炎病毒（HBV）治疗对原发性肝癌根治术后患者复发和生存的影响。方法收集2004年1月至2006年12月期间在我科行根治术的血清HBV DNA阳性的具有完整的临床和随访资料的肝癌患者156例。术后分为单纯手术的对照组80例和同时接受手术和核苷类似物抗病毒治疗的76例，抗病毒方案为口服拉米夫定/阿德福韦酯或恩替卡韦。应用Kaplan-Meier法比较两组术后无复发生存率和总生存率的差异。结果76例接受抗病毒治疗患者术后1 m和3 m血清HBV DNA水平分别为（1.63±1.15）×104 copies/ml和＜1×102copies/ml，较抗病毒前显著降低（P＜0.05），而80例未抗病毒治疗患者血清HBV DNA水平无明显变化；未抗病毒组患者平均无复发生存时间为（10.25±2.56）月，而抗病毒组为[（21.43±3.35）月，P＜0.01]；未抗病毒组和抗病毒组患者1 a、3 a、5 a无复发生存率分别为54.6％、22.3％、0.0%和73.1％、36.2％、23.4％，两组差异有统计学意义（P＜0.05）；未抗病毒组患者平均总生存时间为（18.42±3.21）月，抗病毒治疗组为[（30.28±2.62）月，P＜0.01]；未抗病毒治疗组和抗病毒组患者1 a、3 a、5 a总生存率分别为81.2％、42.0％、16.3％和92.2％、73.4％、31.6％，两组差异有统计学意义（P＜0.05）。结论对于血清HBV DNA阳性的肝癌患者，在根治术后给予规范的抗病毒治疗可以改善预后，延长生存时间。
목적：탐토구복핵감（산）유사물항을형간염병독（HBV）치료대원발성간암근치술후환자복발화생존적영향。방법수집2004년1월지2006년12월기간재아과행근치술적혈청HBV DNA양성적구유완정적림상화수방자료적간암환자156례。술후분위단순수술적대조조80례화동시접수수술화핵감유사물항병독치료적76례，항병독방안위구복랍미부정/아덕복위지혹은체잡위。응용Kaplan-Meier법비교량조술후무복발생존솔화총생존솔적차이。결과76례접수항병독치료환자술후1 m화3 m혈청HBV DNA수평분별위（1.63±1.15）×104 copies/ml화＜1×102copies/ml，교항병독전현저강저（P＜0.05），이80례미항병독치료환자혈청HBV DNA수평무명현변화；미항병독조환자평균무복발생존시간위（10.25±2.56）월，이항병독조위[（21.43±3.35）월，P＜0.01]；미항병독조화항병독조환자1 a、3 a、5 a무복발생존솔분별위54.6％、22.3％、0.0%화73.1％、36.2％、23.4％，량조차이유통계학의의（P＜0.05）；미항병독조환자평균총생존시간위（18.42±3.21）월，항병독치료조위[（30.28±2.62）월，P＜0.01]；미항병독치료조화항병독조환자1 a、3 a、5 a총생존솔분별위81.2％、42.0％、16.3％화92.2％、73.4％、31.6％，량조차이유통계학의의（P＜0.05）。결론대우혈청HBV DNA양성적간암환자，재근치술후급여규범적항병독치료가이개선예후，연장생존시간。
Objective To investigate the difference of recurrence-free survival and overall survival in pa-tients with hepatitis B-related hepatocellular carcinoma receiving and not receiving antiviral therapy. Methods 156 patients with serum HBV DNA positive liver cancer underwent radical resection were randomly selected in our hospital from January 2004 to December 2006. All of them had complete clinical and follow-up data. They were divided into two groups,80 had operation and 76 had postoperative nucleoside analogue antiviral treatment. The antiviral strategies including oral lamivudine and adefovir or entecavir. Kaplan Meier method was applied to compare postoperative recurrence-free survival and overall survival between the two groups. Results The serum HBV DNA loads were (1.63±1.15)×104 copies/ml and less than 1×102copies/ml in 76 patients receiving antiviral therapy one month and three months after operation,much lower than at presentation (P<0.05),while serum HBV DNA loads did not change in 80 patients without antiviral therapy;the recurrence-free survival in 80 patients without antiviral therapy was (10.25±2.56) m,while it was [(21.43±3.35) m,P<0.01] in 76 patients with antiviral therapy;the 1 a,3 a and 5 a recurrence-free survival rates in 80 patients without antiviral treatment were 54.6%, 22.3% and 0.0%,while they were 73.1%,36.2% and 23.4% in 76 patients with antiviral therapy (P<0.05);the overall survival in 80 patients without antiviral therapy was (18.42±3.21)m,while it was [(30.28±2.62)m,P<0.01] in 76 patients with antiviral therapy;the overall survival rates at 1 a,3 a and 5 a in 80 patients without antiviral therapy were 81.2%,42.0% and 16.3%,while they were 92.2%,73.4% and 31.6% in 76 patients with antiviral therapy(P<0.05). Conclusion Standard antiviral treatment can improve prognosis and prolong the total survival in patients with serum HBV DNA positive liver cancer.