Abstract: Objective The purpose of this study was to explore the effect of preoperative serum hepatitis B virus DNA（HBV-DNA） load on postoperative liver function in patients with hepatocellular carcinoma （HCC）. Methods Ninety-one patients were divided into high replication group （30 cases in Group A, preoperative serum HBV-DNA load ≥10⁴ IU/ml）, medium replication group（23 cases in Group B, preoperative serum HBV-DNA load ≥500 IU/ml and <10⁴ IU/ml）, and low replication group （38 cases in Group C, preoperative serum HBV-DNA load <500 IU/ml）based on preoperative serum HBV-DNA load. The operating time, intraoperative blood loss, liver function indexes, postoperative hospital stay of patients were analyzed and compared between the three groups. Results The group A demonstrated a longer operating time compared with the group B and Group C（P<0.05）. The vakues of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） of three groups achieved peak on the 1st day after operation. The values of ALT and AST of patients on the 1st day after operation, group A>group B>group C（P<0.05）. The ALT values of patients on the 3rd day after operation, group A>group B>group C（P<0.05）. The prothrombin time （PT） of Group C was significantly shorter than the Group A and group B on the 1st day after operation（P<0.05）. However, there was no significant difference in intraoperative blood loss, postoperative hospital stay, albumin （ALB） and total bilirubin （TBIL） after operation, and the AST on the 3rd day after operation among the groups（P>0.05）. The group A, the group B and the group C were divided into smaller groups according to preoperative antiviral therapy for 10 days. The operating time, the ALT and AST of patients on the 1st day after operation in the group that the preoperative serum HBV-DNA load ≥10⁴ IU/ml and the preoperative antiviral therapy less than 10 days were significantly higher than those in other groups（P<0.05）. There were two patients in the group that the preoperative serum HBV-DNA load ≥10⁴ IU/ml and the preoperative antiviral therapy was less than 10 days experienced postoperative liver failure, of which one died. Conclusion The HCC patients with highly preoperative serum HBV-DNA load who experienced more severely liver injury after operation, and properly prolonging the time of antiviral therapy before operation may help reduce the occurrence of postoperative liver failure and death.

Key words: hepatitis B virus related hepatocellular carcinoma（HBV-HCC）, hepatitis B virus DNA（HBV-DNA）, liver function, resection, complications

摘要： 目的 探讨术前血清乙型肝炎病毒DNA（HBV-DNA）载量对乙肝相关性肝细胞癌（HBV-HCC）术后肝功能的影响。方法 根据术前血清HBV-DNA载量将91例HBV-HCC分为高复制组（A组30例,HBV-DNA载量≥10⁴ IU/mL）、中复制组（B组23例,HBV-DNA载量≥500 IU/mL,且<10⁴ IU/mL）和低复制组（C组38例,HBV-DNA载量<500 IU/mL）。比较组间手术时长、出血量、术后肝功能指标、术后住院时间的差异。结果 A组手术时间长于B组和C组（P<0.05）。三组丙氨酸氨基转移酶（ALT）及天冬氨酸氨基转移酶（AST）均在术后第1天达到峰值。术后第1天,ALT、AST值A组>B组>C组（P<0.05）;术后第3天,ALT值A组>B组>C组（P<0.05）;术后第1天,C组凝血酶原时间（PT）时间短于A组和B组（P<0.05）。而三组在术中出血量、术后住院时间、术后白蛋白（ALB）、总胆红素（TBIL）和术后第3天AST的差异比较无统计学意义（P>0.05）。另HBV-DNA载量≥10⁴ IU/mL且抗乙肝病毒时间<10 d者,手术时长、术后第1 d 的ALT和AST高于其他患者（P<0.05）;且出现2例术后肝衰竭,1人因肝衰竭而死亡。结论 术前血清HBV-DNA高载量HCC术后肝损伤更严重,术前适当延长抗乙肝病毒时间可能有助于减少术后肝衰竭及死亡的发生。

关键词: 乙肝相关性肝细胞癌（HBV-HCC）, 乙型肝炎病毒DNA（HBV-DNA）, 肝功能, 手术, 并发症