The Impact Of Transcatheter Arterial Chemoembolization On Hepatitis B Virus Reactivation And The Effect Of Lamivudine On The Hepatitis B Virus Reactivation

Background:Primary carcinoma of liver is the No.4cause of death concerned with tumour in the world. There are more than1million new patients every year in our country. It’s high malignant and mainly performs intrahepatic metastasis in the early stage. Because lack of obvious clinical symptom in the early stage, most of the patients are diagnosed in the medium or late stage. According to BCLC, the main treatment of medium and late term hepatocellular carcinoma is TACE which has been well-accepted around the world. A lot of research indicates that TACE can prolong medium and late term patients’life. After TACE the rate of survivors can reach58.1%-61%、24.4%-30.7%and13.7%-18.2%in1,3and5years respectively. However, the rate of survivors after TACE in our country is still not satisfied. Tracing the reasons, it ties up with the following factors:The total infection rate of primary liver cancer in patients with hepatitis B virus is about95%, Ag-positive rate of HBs is more than80%and50%to60%of HCC patients with HBV are at the replication status. The patient’s liver function may therefore progressive deterioration during treatment, cirrhosis gradually increased. Chronic persistent hepatitis B virus infection has a clear impact on liver function and prognosis. Patients with liver cancer Loads of HBV is not only independent factors for hepatitis B related HCC, but the important factor affecting the prognosis, the higher the HBV load, the worse the prognosis of patients. A large number of literature reports the case of the blood system cancer, solid tumors during chemotherapy and after chemotherapy, the liver cancer radiotherapy bone marrow transplantation, especially the use of large doses of immunosuppressive, hepatitis B virus may activate, and there is a occurrence of liver dysfunction, and even the risk of hepatic failure. Therefore, understanding the relationship between the TACE and hepatitis B virus replication status, the incidence of reactivation of hepatitis B virus after the TACE, the impact of HBV re-activation on liver function, close observation of the quantitative changes of hepatitis B virus, and timely usage of antiviral drugs has a great significance on protect liver function, and prolong the survival period. However there are few research and reports in this area currently in our country.Objective:To probe into the impact of transcatheter arterial chemoembolization on hepatitis B virus reactivation and the efficacy of lamivudine in preventing HBV reactivation.Material and method:The patients are collected from2007to2011who were in the treatment of TACE in the Interventional diagnosis department of Nanfang Hospital with HBsAg (+), HBsAb (-) primary liver cancer, a total of66,54male and12female, aging from37to65years old. They were all confirmed by CT, AFP, or needle biopsy. All the66patients’liver function before the operation is of Child A,90points or more in KPS score. Select33cases from2007to2010which on TACE alone treatment as a control group. After Observing hepatitis B virus reactivation in the control group in2010-2011, selected another33patients with liver cancer with the basis of chronic hepatitis B33of HBsAg (+) of HBsAb (-) as a test group. After making agreement with the patients on that, the33patients were planned to take Lamivudine anti-HBV therapy orally and maintain more than one year before TACE. In DSA,66patients were treated with TACE by inserting a cannula into the arteria cruralis.. According to the fact that if catheter tip avoid normal tissue blood vessels and if only stay in the feeding artery of tumor, TACE is divided into ultra-election and non-superselective. The commonly used chemotherapy drugs and dose respectively is: oxaliplatin50-100mg, doxorubicin10-20mg, nasosinusitis10mg, hydroxyl xi tree alkali10mg. Chemotherapy drugs and super liquefied oil are often mixed into the iodine to extend the chemotherapy drug effect time, and do the embolization of the tumor capillary. As the case with some patients, in order to strengthen the effect of embolization, they were required to take PVA and gelatin sponge granules. The group who took lamivudine orally was required to take lamivudine orally more than one year without interruption with0.1g/day before TACE. Observed patients hepatitis B virus DNA quantification, ALT, AST, and TBIL, hepatitis B two half-and-half changesResult:1. There was a significant change for HBV and DNA before and after TACET.TACE may lead to reactivation of hepatitis B virus.2. Compared reactivation rates of hepatitis B virus within two groups, P is0.049, which proof that lamivudine can inhibit reactivation of hepatitis B virus after TACE.3. There is no statistical significance about the liver function of patients with HBV reactivation. The HBV reactivation after TACE had no significant effect on liver function.4. The TACE group HBVeAg positive patients were more prone to hepatitis B virus reactivation (P=0.047).5. It was few chance for the ultra-selected patients with hepatitis B virus reactivation (P=0.031).6. Patients’types of tumor had no significant effect on HBV reactivation.Conclusion:TACE may lead to HBV reactivation, while lamivudine could inhibit HBV reactivation. HBeAg (+) is an index for the prediction of HBV reactivation. Chosen superselective catheterization could prevent HBV reactivation during TACE.