无肝硬化乙肝患者肝癌发病影响因素分析

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (481 KB) RICH HTML
输出: BibTeX | EndNote (RIS)

摘要目的探讨无肝硬化乙肝相关肝癌患者的发病因素。方法收集2004-01至2015-12月我院就诊的原发性肝癌共1000例。根据是否有肝硬化分为肝硬化组(n=934例)及无肝硬化组(n=66例),回顾性分析2组患者的一般情况及实验室检查指标等资料,对无肝硬化乙肝相关肝癌患者的发病因素进行χ²检验及Logistic回归分析。结果单因素分析表明2组患者在年龄、是否饮酒、是否重叠丙型肝炎病毒感染、是否合并高血压、基线血清e抗原状态及血清HBV DNA水平、是否行抗病毒治疗与是否有肝癌家族史方面差异有统计学意义(P<0.05);将其纳入多因素非条件Logistic回归分析,结果提示饮酒(OR=0.176,P=0.002)、有高血压病史(OR=0.505,P=0.039)、基线血清HBV DNA水平偏低(OR=0.031,P＜0.001)、既往未行抗病毒治疗(OR=7.268,P＜0.001)、有肝癌家族史(OR=0.487,P=0.010)是无肝硬化慢性乙型肝炎患者直接进展为原发性肝癌的独立危险因素。结论对于有饮酒史、有高血压病史、基线血清HBV DNA水平偏低、既往未行抗病毒治疗及有肝癌家族史的无肝硬化慢性乙型肝炎患者,应密切监测肝癌的发生。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	魏燕
	杨阳
	王赭
	陈坚
	蒋雪花
	陈勇
	杨龙

关键词 ：乙型肝炎, 肝癌, 肝硬化, 影响因素

Abstract：Objective To investigate the risk factors of hepatitis B virus related hepatocellular carcinoma patients without cirrhosis.Methods A total of one thousand hepatocellular carcinoma patients were collected between January 2004 and December 2015-at Shanghai Corps Hospital of Chinese People’s Armed Police Force. The patients were divided into cirrhosis(n=934) group and non-cirrhosis(n=66) group according to whether there was cirrhosis of the liver. The general information and indexes of laboratory examination in both groups were analyzed retrospectively. χ² test and Logistic regression analysis were performed on the risk factors of hepatitis B virus related hepatocellular carcinoma patients without cirrhosis.Results The univariate analysis indicated that the difference in age, drinking of alcohol, overlap of hepatitis C virus infection, combination with hypertension, baseline serum e antigen status and serum HBV DNA levels, previous antiviral therapy and the family history of liver cancer were statistically significant between the two groups(P<0.05). The multivariate non-conditioned Logistic regression analysis of these eight factors indicated that drinking of alcohol(OR=0.176,P=0.002), combination with hypertension(OR=0.505,P=0.039), lower baseline serum HBV DNA levels (OR=0.031,P＜0.001), previous antiviral therapy (OR=7.268,P＜0.001) and the family history of liver cancer(OR=0.487,P=0.010) were independent risk factors which induce chronic hepatitis B to directly develop into hepatocellular carcinoma without cirrhosis.Conclusions Drinking of alcohol, combination with hypertension, low baseline serum HBV DNA levels, no previous antiviral therapy and the family history of liver cancer patients are possibly associated with the occurrence of hepatocellular carcinoma.

Key words： hepatitis B hepatocellular carcinoma cirrhosis influence factor

收稿日期: 2016-11-14

ZTFLH:

R735.7

通讯作者: 杨龙,E-mail:yyandcg@sina.com

作者简介: 魏燕,本科学历,主治医师。

引用本文:

魏燕,杨阳,王赭,陈坚,蒋雪花,陈勇,杨龙. 无肝硬化乙肝患者肝癌发病影响因素分析[J]. 武警医学, 2017, 28(6): 564-566. WEI Yan,YANG Yang,WANG Zhe,CHEN Jian,JIANG Xuehua,CHEN Yong,and YANG Long. Influencing factors of hepatitis B virus related hepatocellular carcinoma patients without cirrhosis. Med. J. Chin. Peop. Armed Poli. Forc., 2017, 28(6): 564-566.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2017/V28/I6/564

[1]	Chayanupatkul M, Omino R, Mittal S, et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection[J]. J Hepatol, 2017,66(2):355-362.
[2]	Mittal S, El-Serag H B, Sada Y H, et al. Hepatocellular Carcinoma in the Absence of Cirrhosis in United States Veterans is Associated With Nonalcoholic Fatty Liver Disease[J]. Clin Gastroenterol Hepatol, 2016, 14(1): 124-131.
[3]	Albeldawi M, Soliman M, Lopez R, et al. Hepatitis C virus-associated primary hepatocellular carcinoma in non-cirrhotic patients[J]. Dig Dis Sci, 2012, 57(12): 3265-3270.
[4]	Grazi G L, Cescon M, Ravaioli M, et al. Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre[J]. Aliment Pharmacol Ther, 2003, 17(Suppl 2): 119-129.
[5]	中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版)[J].临床肿瘤学杂志,2011,16(10):929-946.
[6]	中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志,2015,31(12):1941-1960.
[7]	Bruix J,Sherman M. Management of hepatocellular carcinoma: an update[J].Hepatology,2011,53(3):1020-1022.
[8]	Do A L, Wong C R, Nguyen L H, et al. Hepatocellular carcinoma incidence in noncirrhotic patients with chronic hepatitis B and patients with cirrhosis of all etiologies[J]. J Clin Gastroenterol, 2014, 48(7): 644-649.
[9]	Kim J M, Kwon C H, Joh J W, et al. Differences between hepatocellular carcinoma and hepatitis B virus infection in patients with and without cirrhosis[J]. Ann Surg Oncol, 2014, 21(2): 458-465.
[10]	Sheron N,Hawkey C,Gilmore I. Projections of alcohol deaths-a wake-up call[J]. Lancet, 2011, 377(9774): 1297-1299.
[11]	Testino G,Leone S,Borro P. Alcohol and hepatocellular carcinoma: a review and a point of view[J].World J Gastroenterol, 2014, 20(43):15943-15954.
[12]	Lin C W,Lin C C,Mo L R,et al.Heavy alcohol consumption increases the incidence of hepatocellular carcinoma in hepatitis B virus-related cirrhosis[J]. J Hepatol, 2013, 58(4): 730-735.
[13]	李佳红,付娜,牛学敏,等. 573例原发性肝癌病因及临床特点分析[J].实用肝脏病杂志,2015, 18(4):399-402.
[14]	郭秀平. 高血压病与乙肝肝硬化及肝癌的关系探讨[J]. 中西医结合心脑血管杂志,2012, 10(12):1522-1523.
[15]	Chen C J,Yang H I. Natural history of chronic hepatitis B REVEALed[J]. J Gastroenterol Hepatol, 2011, 26(4): 628-638.
[16]	Wong G L, Chan H L, Chan H Y, et al. Accuracy of risk scores for patients with chronic hepatitis B receiving entecavir treatment[J]. Gastroenterology, 2013,144(5):933-944.