围术期抗病毒药物减少经动脉化疗栓塞后的HBV再激活

StephenW

Virginia Schad, PharmD
June 25, 2018
Perioperative Antivirals Reduce HBV Reactivation After Transarterial Chemoembolization

Independent risk predictors for HBV reactivation in this study included HBeAg-positive status, more than 3 tumors, and absence of antiviral therapy. Independent risk predictors for HBV reactivation in this study included HBeAg-positive status, more than 3 tumors, and absence of antiviral therapy.

Perioperative antiviral therapy may reduce the risk for hepatitis B virus (HBV) reactivation and improve liver function after transarterial chemoembolization (TACE) in patients with primary hepatocellular carcinoma (HCC), according to a study published in Medicine.1

TACE is currently the standard nonsurgical treatment for patients with intermediate- or advanced-stage HCC; however, HBV reactivation can occur following TACE, which may lead to fatal results including liver failure.2-5 It is unclear whether antiviral therapy reduces the risk for post-TACE HBV reactivation in patients who are negative for HBV DNA.1

Therefore, researchers in China prospectively evaluated 98 patients with HBV-related and HBV DNA-negative HCC who underwent TACE to study the effects of TACE combined with antiviral therapy.

Of these patients, 51 received entecavir 0.5 mg/day starting 3 days before TACE and for at least 1 month afterward. The rate of HBV reactivation and liver function was assessed before and after only 1 session of TACE, on average 1 month after the procedure.

The researchers found that HBV reactivation occurred in only 3 patients in the antiviral group but in 11 patients in the nonantiviral group (5.9% vs 23.4%, respectively; P < .05).

Independent risk predictors of HBV reactivation included hepatitis B envelope antigen-positive status, the presence of more than 3 tumors, and the absence of antiviral therapy. At 5 days after TACE, liver function did not differ significantly between the antiviral and nonantiviral groups.

However, the level of alanine aminotransferase and bilirubin were increased and albumin level was decreased in patients who experienced HBV reactivation compared with those who did not (P < .05).


At 1 month after TACE, liver function indicators did not differ significantly between patients who did and did not experience HBV reactivation.

“Initiation of antiviral therapy for patients before TACE significantly reduced the risk for HBV reactivation and protected liver function,” concluded the study authors.1
References

    Wang K, Jiang G, Jia Z, Zhu X, Ni C. Effects of transarterial chemoembolization combined with antiviral therapy on HBV reactivation and liver function in HBV-related hepatocellular carcinoma patients with HBV-DNA negative. Medicine (Baltimore). 2018;97(22):e10940.

StephenW

Virginia Schad，PharmD
2018年6月25日
围术期抗病毒药物减少经动脉化疗栓塞后的HBV再激活

本研究中HBV再激活的独立风险预测因子包括HBeAg阳性状态，超过3种肿瘤和无抗病毒治疗。本研究中HBV再激活的独立风险预测因子包括HBeAg阳性状态，超过3种肿瘤和无抗病毒治疗。

根据发表在医学杂志上的一项研究，围手术期抗病毒治疗可降低原发性肝细胞癌（HCC）患者经动脉化疗栓塞术（TACE）后乙型肝炎病毒（HBV）再激活的风险和改善肝功能。

TACE目前是中，晚期HCC患者的标准非手术治疗方案;然而，在TACE后可能发生HBV再激活，这可能导致包括肝功能衰竭在内的致命结果.2-5目前还不清楚抗病毒治疗是否能降低HBV DNA阴性患者TACE后HBV再激活的风险。

因此，中国的研究人员对98名接受TACE的HBV相关和HBV DNA阴性的HCC患者进行前瞻性评估，以研究TACE联合抗病毒治疗的效果。

这些患者中，51例在TACE前3天开始接受恩替卡韦0.5 mg /天，至少1个月后接受恩替卡韦治疗。在术后1个月平均仅1次TACE之前和之后评估HBV再激活率和肝功能。

研究人员发现，抗病毒组仅有3例患者发生HBV复发，而非抗病毒组有11例患者发生HBV再激活（分别为5.9％和23.4％; P <0.05）。

HBV再激活的独立风险预测因子包括乙肝包膜抗原阳性状态，超过3个肿瘤的存在以及缺乏抗病毒治疗。在TACE后5天，抗病毒和非抗病毒组之间的肝功能没有显着差异。

然而，与未接受治疗的患者相比，HBV再激活患者的丙氨酸转氨酶和胆红素水平升高，白蛋白水平降低（P <0.05）。


在TACE后1个月，肝功能指标在没有和没有经历HBV再激活的患者之间没有显着差异。

“在TACE之前为患者开始抗病毒治疗显着降低了HBV再激活和保护肝功能的风险，”研究作者总结说。
参考

    王珂，蒋，，贾志强，朱，，倪trans。经动脉化疗栓塞联合抗病毒治疗对HBV相关肝细胞癌患者HBV-DNA阴性HBV再激活及肝功能的影响。医学（巴尔的摩）。 2018; 97（22）：e10940。