【作者】 王卫兵；

【导师】 郑树森；

【作者基本信息】 浙江大学 ， 外科学， 2011， 硕士

【摘要】 目的：肝细胞肝癌是全球发病率及死亡率均较高的恶性肿瘤之一。在我国,乙肝病毒感染是肝癌的最主要病因,但酒精也是发生肝癌的重要危险因素。本研究对乙肝病毒相关性肝癌(hepatitis B virus-related hepatocellular carcinoma)手术患者的临床资料进行回顾性分析,以评价酒精和乙肝对肝癌患者的影响。方法：2010年3月至2011年3月,浙江大学医学院附属第一医院共进行肝癌手术342例,选取行局部或肝段切除的小肝癌(单个或两个最大直径之和>5cm)且有乙肝背景(HBsAg+)的病例共164例,根据是否有长期饮酒(饮酒时间>5年,折合酒精量男性≥40g/d,女性≥20g/d)及术前HBV-DNA>104拷贝/ml或≤104拷贝/m1分成四组：饮酒乙肝高负荷(A+H+组),饮酒乙肝低负荷(A+H-组),非饮酒乙肝高负荷(A-H+组).非饮酒乙肝低负荷(A-H-组),比较四组之间的临床数据。结果：全组164例乙肝相关肝癌患者,A+H+组共29例(17.7%),饮酒时间为23.4±9.2年,饮酒量199.3+145.3g/d；A+H-组共25例(15.2%),饮酒时间为23.3±9.6年,饮酒量113.3±80.1g/d;A-H+组共36例(22.0%),无饮酒史;A-H-组共74例(45.1%),无饮酒史。各组间发病年龄无明显差异。A+H+组比A+H-组术前血清Alb明显较低(41.9±5.0g/L vs.44.5±5.1 g/L,=0.03),术前血ALT明显较高(51.5±25.0U/Lvs.32.0±13.2 U/L,P=0.013),术前血AST也明显较高(42.9±14.1U/L vs.30.7±14.9 U/L,P=0.015);术后第1天血清Alb恢复明显缓慢(32.9±5.0 g/Lvs.35.4±5.6 g/L,P=0.04),术后第7天血清Alb恢复显著缓慢(34.7±4.1g/L vs.38.2±4.2 g/L,P=0.007),肿瘤直径明显较大(3.4±1.0cmvs.2.5±.1cm, P=0.003).A+H+组比A-H-组术前血清Alb明显较低(41.9±5.0 g/L vs.44.3±3.9 g/L.P=0.013),术前血ALT明显较高(51.5±25.0 U/L vs.32.5±29.9 U/L,P=0.002),术前血AST也明显较高(42.9±14.1 U/L vs.30.7±17.4 U/L,P=0.002);术后第1天血清Alb恢复明显缓慢(32.9±5.0 g/L vs.36.0±5.5 g/L,=0.01),术后第7天血清Alb恢复显著缓慢(34.7±4.1 g/L vs.37.7±4.5 g/L,P=0.003)。其余各组间的ALT、AST、TB、Che、ICG15m、AFP等均无明显差异。肿瘤大小、数目和分化程度方面也无明显差异。结论：1.慢性饮酒与乙肝病毒高负荷对肝脏功能损害有协同作用。慢性饮酒背景下,乙肝病毒高负荷降低肝脏术前合成功能和延缓术后合成功能的恢复,且使肝酶代谢受损。2.慢性饮酒背景下,乙肝病毒高负荷使得肝癌肿瘤的直径较大。更多还原

【Abstract】 Background:Hepatocellular carcinoma (HCC) is one of the most common cancers in the worldwide. The incidence and mortality associated with HCC are increasing. In China, the hepatitis B virus (HBV) infection is the most important cause of HCC, and alcohol is also an important risk factor for HCC. To evaluate the effects of alcohol in the HBV-related HCC, the data of the surgical patients were retrospectively analyzed.Methods:There were 164 patients with the background of hepatitis B (HBsAg+) undergoing local or liver segment resection(one or two of the largest diameter and< 5cm) between March 2010 to March 2011 in our hospital. Depending on whether long-term drinking (drinking time>5 years, equivalent to the amount of alcohol men >40g/d, women>20g/d) and preoperative HBV-DNA>104 copies/ml or≤104 copies/ml, the total cases are divided into four groups:drinking with high HBV load (A+H+ group), drinking with low HBV load (A+H-group), non-drinking with high HBV load (A-H+group), non-drinking with low HBV load (A-H-group), compared clinical data between the four groups. Results:The whole group of 164 HCC patients, there were 29 patients (17.7%) in the A+H+group, the drinking time was 23.4±9.2 years, alcohol consumption was 199.3±145.3g/d; and there were 25 patients (15.2%) in the A+H-group, drinking time was 23.3±9.6 years, alcohol consumption was 113.3±80.lg/d; A-H+group had 36 patients (22.0%) and no history of drinking; A-H-group had 74 patients (45.1%) and no drinking history. Each group no significant difference between the age of onset. Compared with the A+H-group, the preoperative serum Alb of A+H+group was significantly lower(41.9±5.0 g/L vs.44.5±5.1 g/L,P=0.03), preoperative serum ALT was significantly higher(51.5±25.0 U/L vs.32.0±13.2 U/L,P=0.013), preoperative serum AST was significantly higher(42.9±14.1 U/L vs.30.7±14.9 U/L.P=0.015); one day postoperative serum Alb was significantly slower recovery (32.9±5.0 g/L vs. 35.4±5.6 g/L.P=0.04), seven days postoperative serum Alb was significantly slower recovery(34.7±4.1 g/L vs.38.2±4.2 g/L,P=0.007), tumor diameter was significantly larger (3.4±1.0cm vs.2.5±.1cm, P=0.003). Compared with the A-H-group, the preoperative serum Alb of A+H+group was significantly lower(41.9±5.0 g/L vs. 44.3±3.9 g/L,P=0.013), preoperative serum ALT was significantly higher(51.5±25.0 U/L vs.32.5±29.9 U/L.P=0.002), preoperative serum AST was significantly higher(42.9±14.1 U/L vs.30.7±17.4 U/L,P=0.002); one day postoperative serum Alb was significantly slower recovery (32.9±5.0 g/L vs.36.0±5.5 g/L.P=0.01), seven days postoperative serum Alb was significantly slower recovery(34.7±4.1 g/L vs.37.7±4.5 g/L,P=0.003). There was no significant difference among other groups about ALT, AST. TB, Che, ICG15m, AFP, etc. Tumor size, number and differentiation are also no significant differences. Conclusion:1. Chronic alcohol consumption and high load of HBV have a synergistic effect in the liver function. In the background of chronic alcohol consumption, the high load of HBV decreases preoperative liver synthetic function and delays the postoperative recovery of hepatic synthetic function, and damaged the metabolism of liver enzymes.2. In the background of chronic alcohol consumption, the high load of HBV makes the larger diameter of HCC.更多还原