探讨HBV相关性肝细胞癌（肝癌）切除术后患者抗HBV的疗效。

回顾性分析2008年1月至2013年1月上海交通大学附属第六人民医院、附属第一人民医院及上海交通大学医学院附属瑞金医院收治的87例HBV相关性肝癌切除术后患者临床资料。其中男40例，女47例；年龄<55岁32例，≥55岁55例。患者均签署知情同意书，符合医学伦理学规定。根据肿瘤直径分为肿瘤直径≤3 cm组（36例）和>3 cm组（51例）。每组根据有否抗HBV治疗分为抗HBV亚组和非抗HBV亚组。抗HBV治疗的患者术后14 d开始接受恩替卡韦治疗。观察各组患者术后6个月ALT及HBV-DNA抑制率变化。ALT及HBV-DNA抑制率比较采用t检验，生存分析采用Kaplan-Meier法和Log-rank检验，影响因素分析采用Cox比例风险回归模型。

肿瘤直径≤3 cm组患者中抗HBV亚组的HBV-DNA抑制率（47±6）%明显高于非抗HBV亚组的（9±3）%（t=3.142，P<0.05）；抗HBV亚组ALT从治疗前的（46±10）U/L下降至治疗后的（34±8）U/L，差异有统计学意义（t=-2.339，P<0.05）。肿瘤直径≤3 cm组中，抗HBV亚组患者的中位无病生存时间为48个月，非抗HBV亚组为35个月，两组无病生存率比较差异有统计学意义（χ²=13.09，P<0.05）。术后抗HBV治疗、血清AFP>400μg/L是肿瘤直径≤3 cm患者无病生存的独立影响因素（OR=0.220，2.657；P<0.05）。

术后抗HBV治疗是小肝癌患者无病生存的独立影响因素，抗HBV治疗可通过改善残肝功能提高患者生存率。

To investigate the effect of anti hepatitis B virus (HBV) therapy on patients with HBV associated hepatocellular carcinoma (HCC) after resection.

Clinical data of 87 patients with HBV associated HCC after resection treated in Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Affiliated First People's Hospital and Ruijin Hospital, Shanghai Jiaotong University from January 2008 to January 2013 were retrospectively analyzed. There were 40 males and 47 females, 32 cases were <55 years old and 55 cases were ≥55 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the tumor diameter, the patients were divided into the tumor diameter ≤3 cm group (n=36) and >3 cm group (n=51). According to whether the patients had received anti HBV therapy, each group was divided into anti HBV subgroup and non-anti HBV subgroup. Patients with anti HBV therapy began to receive treatment of entecavir 14 d after operation. The changes of alanine aminotransferase (ALT) and inhibition rate of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) 6 months after operation were observed in each group. The ALT and inhibition rate of HBV-DNA were compared using t test, survival analysis was conducted using Kaplan-Meier method and Log-rank test, and influencing factors analysis was conducted using Cox proportional hazard regression model.

In the tumor diameter ≤3 cm group, the inhibition rate of HBV-DNA in the anti HBV subgroup was (47±6) %, which was higher than (9±3) % in the non-anti HBV subgroup (t=3.142, P<0.05). And in the anti HBV subgroup, the ALT level decreased from (46±10) U/L before treatment to (34±8) U/L after treatment, where significant difference was observed (t=-2.339, P<0.05). In the tumor diameter ≤3 cm group, the median of disease-free survival (DFS) time of the patients in the anti HBV subgroup was 48 months, and was 35 months in the non-anti HBV subgroup, and significant difference was observed between two groups (χ²=13.09, P<0.05). Anti HBV therapy after operation and serum alpha-fetoprotein (AFP) level >400 μg/L were the independent factors for the DFS of patients with tumor diameter ≤3 cm (OR=0.220, 2.657; P<0.05).

Postoperative anti HBV therapy is an independent influencing factor for the DFS of patients with small HCC. Anti HBV therapy can raise the survival rate by improving the residual liver function of patients.