【摘要】 目的 比较载药微球肝动脉化疗栓塞(Drug-eluting bead transarterial chemoembolization, DEB-TACE)和传统肝动脉栓塞化疗术(Conventional transarterial chemoembolization, cTACE)治疗乙肝肝癌(Primary liver cancer after hepatitis B,PLCAHB)的临床疗效及安全性。方法 选择2018年1月-2022年12月在我院接受cTACE治疗的57例PLCAHB患者为对照组，以同期在我院接受DEB-TACE治疗的63例PLCAHB患者为观察组。观察2组患者术前、术后3个月、6个月、12个月时乙型肝炎病毒脱氧核糖核酸载量(Hepatitis B virus deoxyribonucleic acid load, HBV DNA)载量水平；记录2组患者不良反应(包括发热、恶心、呕吐、厌食等)发生率；于术前、术后3个月、6个月时抽取2组患者静脉血，采用生化仪检测谷草转氨酶(Aspartate aminotransferase, AST)、谷丙转氨酶(Alanine aminotransferase, ALT)、直接胆红素(Direct bilirubin, DBIL)、间接胆红素(Total bilirubin, TBIL)等肝功能指标水平；于术后1个月、6个月观察2组患者的临床有效率=[完全缓解(Complete response, CR)率+部分缓解(Partial response, PR)率]。参考改良实体瘤疗效评价标准(Modified response evaluation criteria in solid tumors, mRECIST)进行疗效评估，对患者进行磁共振(Magnetic resonance imaging, MRI)检查，观察病灶情况，CR指靶病灶强化区域完全消失，PR指基线病灶长径总和缩小≥30%。对所有患者进行随访，记录患者无进展生存期(Progression-free survival, PFS)、总生存期(Overall survival, OS)和2年存活率。结果 与本组术前比较，术后3个月、6个月、12个月时2组患者HBV DNA载量降低；术后3月时观察组患者AST水平升高，术后3个月、6个月时2组患者DBIL和TBIL水平升高，差异均有统计学意义(P<0.05)。与对照组比较，观察组围术期发热、恶心、呕吐、厌食等不良反应发生率降低；术后3个月时AST和DBIL水平升高；术后6个月时DBIL水平降低，临床有效率升高；观察组患者PFS、OS、2年存活率升高，差异均有统计学意义(P<0.05)。结论 DEB-TACE治疗PLCAHB的临床疗效和安全性均优于cTACE。更多还原

【Abstract】 Objective To compare the clinical efficacy and safety of drug loaded microspheres transarterial chemoembolization(DEB-TACE) and conventional transarterial chemoembolization(cTACE) in the treatment of primary liver cancer after hepatitis B B(PLCAHB). Methods Select 57 PLCAHB patients who received cTACE treatment in the hospital from January 2018 to December 2022 as the control group, and 63 PLCAHB patients who received DEB-TACE treatment in the hospital during the same period as observation group. Observe the levels of hepatitis B virus deoxyribonucleic acid load(HBV DNA) in 2 groups of thepatients before surgery and at 3, 6 and 12 months after surgery; Recorded the incidence of adverse reactions(including fever, nausea, vomiting, anorexia, etc.) in 2 groups of the patients; Venous blood samples were collected from 2 groups of the patients before surgery and at 3 and 6 months after surgery. Liver function indicators such as aspartate aminotransferase(AST), alanine aminotransferase(ALT), direct bilirubin(DBIL) and total bilirubin(TBIL) were measured using a biochemical analyzer; Observed the clinical effective rate of 2 groups of the patients at 1 and 6 months after surgery=[Complete response(CR) rate+Partial response(PR) rate]. Refered to the Modified Response Evaluation Criteria in Solid Tumors(mRECIST) for efficacy evaluation, performed magnetic resonance imaging(MRI) on patients, observed the lesion condition, CR refered to complete disappearance of the target lesion enhancement area, and PR refers to a reduction of ≥30% in the total length and diameter of the baseline lesion. Followed up all patients and recorded their progression free survival(PFS), overall survival(OS) and 2-year survival rate. Results Compared with preoperative results, the HBV DNA load of both groups of patients weredecreased at 3, 6 and 12 months postoperatively; At 3 months after surgery, the AST levels in the observation group were increased, and at 3 and 6 months after surgery, the DBIL and TBIL levels in both groups were increased, with significant differences(P<0.05). Compared with control group, the incidence of adverse reactions such as fever, nausea, vomiting and anorexia during the perioperative period was reduced in the observation group; At 3 months postoperatively, the AST and DBIL levels of the observation group patients wereincreased, while at 6 months postoperatively, the DBIL levels of the observation group patients were decreased. At 6 months after surgery, the clinical effective rate of the observation group patients was increased. The PFS, OS and 2-year survival rate of the observation group patients were increased, and the differences were statistically significant(P<0.05). Conclusion DEB-TACE has better clinical efficacy and safety than cTACE in the treatment of PLCAHB.更多还原