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目的:探讨恩替卡韦联合介入方法治疗乙型肝炎相关原发性肝癌(HBVR-HCC)的临床疗效。方法:选择2007年2月—2011年2月85例确诊为HBVR-HCC、没有手术治疗适应证的患者,其中44例采用恩替卡韦联合肝动脉段性化疗栓塞(TACE)治疗(观察组),41例单纯采用TACE治疗(对照组),分析两组治疗前和治疗后4、12、24、48周HBV-DNA水平、肝功能、AFP水平和ChildPugh评分,并比较两组的临床疗效、不良反应以及生存状况。结果:随治疗时间延长,观察组HBV-DNA水平逐渐降低,而对照组逐渐升高,两组差异在治疗后各时间点均有统计学意义(均P<0.05);两组谷丙转氨酶(ALT)与AFP水平、逐渐降低,但观察组在治疗24周后的降低程度明显优于对照组(均P<0.05);两组Child-Pugh评分逐渐升高,但观察组在治疗24周后的升高程度低于对照组(P<0.05)。观察组HCC的治疗有效率明显高于对照组,并发症和不良反应均明显低于对照组(均P<0.05)。两组的1年生存率的差异无统计学意义(P>0.05),但观察组2年生存率和中位生存期优于对照组(均P<0.05)。结论:TACE对HBV活动存在激发作用,抗病毒联合TACE治疗HBVR-HCC可有效控制HBV,改善患者的肝功能,提高临床疗效,且不增加毒副作用。
Objective: To investigate the clinical efficacy of entecavir combined with interventional therapy in the treatment of hepatitis B-related primary hepatocellular carcinoma (HBVR-HCC). Methods: Eighty-five patients with HBVR-HCC diagnosed as having no evidence of surgical treatment were enrolled from February 2007 to February 2011, of which 44 were treated with entecavir in combination with hepatic arterial chemoembolization (TACE), 41 Cases of pure TACE treatment (control group), analysis of two groups before and after treatment 4, 12, 24, 48 weeks of HBV-DNA levels, liver function, AFP levels and ChildPugh score, and to compare the clinical efficacy of the two groups, adverse reactions And living conditions. Results: With the prolongation of treatment time, the levels of HBV-DNA in the observation group decreased gradually and the control group gradually increased, the difference between the two groups was statistically significant at all time points after treatment (all P <0.05). The levels of alanine aminotransferase ALT) and AFP levels gradually decreased, but the decrease of observation group was better than that of control group (all P <0.05) after 24 weeks of treatment; Child-Pugh score of two groups increased gradually, but in observation group after 24 weeks of treatment The level of increase was lower than the control group (P <0.05). Observation group HCC treatment efficiency was significantly higher than the control group, complications and adverse reactions were significantly lower than the control group (P <0.05). There was no significant difference in one-year survival rate between the two groups (P> 0.05), but the 2-year survival rate and median survival time in the observation group were better than those in the control group (all P <0.05). Conclusion: TACE can stimulate the activity of HBV. Antiviral combined with TACE treatment of HBVR-HCC can effectively control HBV, improve liver function and improve clinical efficacy without increasing the side effects.