慢性乙型肝炎肝硬化患者发生肝细胞癌的危险因素分析

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摘要：目的 探讨乙型肝炎肝硬化患者发生肝细胞癌(HCC)的危险因素. 方法 收集2009年1月至2014年9月在复旦大学附属中山医院就诊的来自上海及周边地区的汉族乙型肝炎肝硬化患者资料,将其分为肝硬化组和HCC组.收集患者病史、血清学、影像学及病理检查资料,比较两组间的一般情况及临床检测数据,用SPSS 19.0统计软件进行包括采用x2检验的单因素分析和logistic多因素回归分析的统计学分析.结果 共收集715例患者资料,其中肝硬化组281例,HCC组434例.单因素分析结果显示男性、年龄≥50岁,有肝癌家族史、饮酒史、脂肪肝、可检出HBV DNA、未得到有效的抗病毒治疗与乙型肝炎肝硬化患者发生HCC显著相关.多因素回归分析结果显示年龄≥50岁(P=0.005,OR=1.766)、饮酒史(P=0.002,OR=2.570)、肝癌家族史(P=0.014,OR=2.268)、脂肪肝(P=0.023,OR=3.390)、未得到有效的抗病毒治疗(P＜ 0.001,OR=5.389)是乙型肝炎肝硬化患者发生HCC的危险因素.达到持续病毒学抑制(SVS)的乙型肝炎肝硬化患者仍可能发生HCC,HBV感染家族史(P=0.014,OR=2.537)、肝癌家族史(P=0.037,OR=3.339)和脂肪肝(P=0.018,OR=11.646)与达到SVS的乙型肝炎肝硬化患者发生HCC显著相关.结论 乙型肝炎肝硬化患者并发HCC的独立危险因素包括年龄≥50岁、饮酒史、肝癌家族史、脂肪肝和未得到有效的抗病毒治疗.HBV感染家族史、肝癌家族史和脂肪肝是达到SVS的乙型肝炎肝硬化患者发生HCC的危险因素.
Abstract：Objective To identify risk factors of hepatocellular carcinoma (HCC) in cirrhotic patients with chronic hepatitis B (CHB).Methods A total of 715 cirrhotic patients with CHB were recruited from the Zhongshan Hospital Affiliated to Fudan University and enrolled in this case-control study between January 2009 and September 2014.All participants were Chinese Han residing in Shanghai and the surrounding areas.The patients were divided into a cirrhosis group (n =281) and a HCC group (n=434).History of hepatitis B infection and HCC,as well as clinical data from serological,imaging and pathological examinations were collected for analysis.SPSS software,version 19.0,was used for all statistical comparisons.Results Single factor analysis indicated that development of HCC in cirrhotic patients with CHB was significantly associated with male sex,age of 50 years or more,family history of HCC,alcohol consumption,fatty liver,detectable levels of hepatitis B virus (HBV) DNA,and history of HBV infection without effective antiviral treatment.Multivariate logistic regression analysis indicated that age of 50 years or more (P =0.005,odds ratio [OR] =1.766),history of alcohol consumption (P =0.002,OR =2.570),family history ofHCC (P =0.014,OR =2.268),fatty liver (P =0.023,OR =3.390),and history of HBV infection without effective antiviral treatment (P ＜ 0.001,OR =5.389) were risk factors of HCC.The risk factors for development of HCC in cirrhotic patients with hepatitis B after achieving sustained virologic suppression (SVS) were family history of HBV infection (P =0.014,OR =2.537),family history ofHCC (P =0.037,OR =3.339) and fatty liver (P =0.018,OR =11.646).Conclusion Risk factors of HCC in cirrhotic patients with CHB include age,drinking history,family history of HCC,fatty liver,and ineffective antiviral treatment of CHB.Family history of HBV infection or HCC,and fatty liver disease,were significantly associated with HCC development after SVS in patients with hepatitis B-related cirrhosis.
doi：10.3760/cma.j.issn.1007-3418.2015.07.009
作者：张原青 彭利军 曹忆嵘 曾志萍 吴玉婧 石虹 陈世耀 郭津生
作者单位： 复旦大学附属中山医院消化科, 上海,200032
刊 名：中华肝脏病杂志 ISTICPKU
Journal：Chinese Journal of Hepatology

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