CAJ | 학술논문

目的：通过观察乙型肝炎(乙肝)相关性肝癌患者行肝癌根治性切除术术前、术后血清乙肝病毒DNA ( HBV-DNA)载量、血清炎症因子的变化,探讨HBV二次激活的因素。方法将行肝癌根治性切除术、尚未达到抗病毒标准的60例乙肝相关性肝癌纳入研究,检测术前及术后第3天HBV-DNA、IL-6、IL-10、IL-27水平。根据术后第3天HBV-DNA载量变化将60例分为升高组( HBV-DNA载量升高1个及1个以上数量级)及正常组( HBV-DNA载量无变化或者升高不足1个数量级)。比较两组一般资料,筛选出影响HBV-DNA载量变化的相关因素进行多因素logistic回归分析。结果①术后第3天HBV-DNA载量较治疗前升高1个及1个以上数量级者27例(升高组),其中21例(77.78%)术前HBV-DNA载量<104 U/ml；HBV-DNA载量较治疗前无变化或者升高不足1个数量级者33例(正常组)。②logistic分析显示,肿瘤直径、肝切除范围、术中注射无水酒精是导致患者术后HBV-DNA载量升高的独立危险因素。③与本组术前比较,升高组术后第3天血清IL-10、IL-27水平升高(P<0．01),IL-6无显著变化(P>0．05)；正常组术后第3天血清IL-6、IL-27水平升高,IL-10水平降低,差异均有统计学意义(P<0．05,P<0．01)。结论手术应激及其引起炎症因子IL-6及IL-10水平变化是乙肝相关性肝癌患者肝癌根治性切除术后HBV二次激活的可能机制；围术期监测患者HBV-DNA载量变化具有重要意义。
목적：통과관찰을형간염(을간)상관성간암환자행간암근치성절제술술전、술후혈청을간병독DNA ( HBV-DNA)재량、혈청염증인자적변화,탐토HBV이차격활적인소。방법장행간암근치성절제술、상미체도항병독표준적60례을간상관성간암납입연구,검측술전급술후제3천HBV-DNA、IL-6、IL-10、IL-27수평。근거술후제3천HBV-DNA재량변화장60례분위승고조( HBV-DNA재량승고1개급1개이상수량급)급정상조( HBV-DNA재량무변화혹자승고불족1개수량급)。비교량조일반자료,사선출영향HBV-DNA재량변화적상관인소진행다인소logistic회귀분석。결과①술후제3천HBV-DNA재량교치료전승고1개급1개이상수량급자27례(승고조),기중21례(77.78%)술전HBV-DNA재량<104 U/ml；HBV-DNA재량교치료전무변화혹자승고불족1개수량급자33례(정상조)。②logistic분석현시,종류직경、간절제범위、술중주사무수주정시도치환자술후HBV-DNA재량승고적독립위험인소。③여본조술전비교,승고조술후제3천혈청IL-10、IL-27수평승고(P<0．01),IL-6무현저변화(P>0．05)；정상조술후제3천혈청IL-6、IL-27수평승고,IL-10수평강저,차이균유통계학의의(P<0．05,P<0．01)。결론수술응격급기인기염증인자IL-6급IL-10수평변화시을간상관성간암환자간암근치성절제술후HBV이차격활적가능궤제；위술기감측환자HBV-DNA재량변화구유중요의의。
Objective To observe the changes of serum hepatitis B virus DNA ( HBV-DNA) capacities and in-flammatory factors before and after the hepatic carcinectomy in patients with HBV-related hepatocellular carcinoma ( HCC) , and to investigate the risk factors of the second activated HBV DNA. Methods A total of 60 HBV-related HCC patients undergoing hepatic carcinectomy without the recommended level of antiviral treatment were recruited in this study. The levels of serum HBV-DNA, IL(interleukin)-6, IL-l0 and IL-27 before and on the 3rd d after the operation were detected. The patients were divided into the increasing group ( increasing HBV-DNA load ≥1 magnitude order) and normal group (increasing HBV-DNA load≤1 magnitude order) according to HBV-DNA loads on the 3rd d after the operation. The general data in the two groups were compared, and then logistic regression analysis was performed for choosing related factors of HBV-DNA loads. Results There were 27 patients in the increasing group including 21 pa-tients (77. 78%, 21/27) with preoperative serum levels of HBV-DNA less than 104 U/ml;there were 33 patients in the normal group. Logistic regression analysis showed that tumor diameter, hepatectomize extent and intraoperative anhydrous alcohol injection were independent risk factors for postoperative HBV-DNA load increases. Compared with those before the operation, in the increasing group on the 3rd d after the operation, serum IL-10 and IL-27 levels were significant in-creased (P<0. 01), but there was no significant difference in IL-6 level (P>0. 05). Compared with those before the operation, in normal group, serum on the 3rd d after the operation, serum IL-6 and IL-27 levels were increased, while IL-10 level was decreased, and the differences were statistically significant (P<0. 05, P<0. 01). Conclusion Surgical stress and its induced changes of inflammatory factors IL-6 and IL-l0 levels may be possible mechanisms of the second ac-tivated HBV-DNA in patients with HBV-related hepatocellular carcinoma after the hepatic carcinectomy, and it is impor-tant to monitor changes of HBV-DNA load in perioperative patients.