乙肝相关性原发性肝癌抗病毒治疗的回顾性分析

发布时间：2018-05-27 07:26

本文选题：乙肝 + 原发性肝癌　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:观察抗病毒治疗对乙肝相关性原发性肝癌患者临床指标的影响,客观评价抗病毒治疗的作用,以此说服拒绝抗病毒治疗的此类患者应当进行抗病毒治疗;探讨影响乙肝相关性原发性肝癌患者抗病毒疗效的独立影响因素,为临床治疗此类疾病提供一些理论和实践依据。方法:回顾性分析2010年6月~2016年06月在广西中医药大学附属瑞康医院住院的首次诊断为乙肝相关性原发性肝癌患者的完整临床资料,按纳入标准及排除标准筛选出418例患者纳入本次研究。根据是否使用核苷(酸)类似物抗病毒治疗,抗病毒药物为首次使用,将238例进行抗病毒治疗的患者作为抗病毒组,将180例拒绝抗病毒治疗的患者作为对照组。比较首诊时、治疗后3、6、12月两组的相关临床资料及指标,包括性别、年龄、个人史(吸烟史、饮酒史)、家族史、抗病毒药物类型,主要临床症状体征(肝区疼痛、消瘦、黄疸、腹水)、TBIL、ALB、ALT、AST、PT、AFP、HBe Ag、HBV DNA、Child-Pugh评分、影像学分型(块状型、结节型)、组织学病理分型(肝细胞型肝癌HCC、肝内胆管细胞型肝癌ICC、混合型)。对可能影响抗病毒疗效的主要相关因素进行分析,对有显著性差异的因素进行单因素Logistic回归分析,为达到控制混杂因素干扰的目的,再对单因素分析中P0.05的变量运用多因素非条件Logistic回归分析筛选出影响抗病毒疗效的独立影响因素。结果:(1)418例患者中男性有369例,女性49例,男女比例为7.53:1;平均年龄为(45.68±12.08)岁,45~59岁有131例,占31.34%,45岁有228例,其中≤30岁有29例,占该人群的12.72%。(2)两组首诊时相关临床指标比较无差异(P0.05);抗病毒治疗3、6月后,抗病毒组较对照组在肝区疼痛缓解率、黄疸缓解率、腹水缓解率、PT缩短时间、TBIL、ALB、ALT、AST、AFP、HBV DNA、Child-Pugh评分、HCC、ICC等方面均获得较明显的改善,差异有统计学意义(P0.05);抗病毒治疗12月后,抗病毒组HBe Ag改善优于对照组,差异有统计学意义(P0.05),抗病毒组AFP(38.56±17.82)u g/L、HBV DNA阴转率89.50%,对照组分别为(252.59±132.23)u g/L、3.33%,比较有显著性差异(P0.05);有肝癌家族史并行抗病毒治疗患者78例,抗病毒6个月后,女性在TBIL、ALT、AFP、HBV DNA、Child-Pugh评分等方面的改善均优于男性,差异均有统计学意义(P0.05)。(3)单因素Logistic回归分析显示药物类型、饮酒史、家族史、黄疸、腹水、PT、HBe Ag阳性、HBV DNA、Child-Pugh评分、块状型、HCC进入多因素方程;多因素非条件Logistic回归分析显示药物类型(OR=5.376,95%CI 1.842~34.259)、饮酒史(OR=5.629,95%CI 2.052~15.443)、HBe Ag阳性(OR=13.821,95%CI 4.217~45.292)、HBV DNA(OR=0.534,95%CI 0.343~0.829)、块状型(OR=5.424,95%CI 2.006~14.666)、HCC(OR=13.546,95%CI 4.341~42.264)均为影响抗病毒疗效的独立影响因素。结论:(1)乙肝相关性原发性肝癌患者男性明显多于女性,以中年患者居多,但发病年龄年轻化明显。(2)乙肝相关性原发性肝癌患者抗病毒治疗可以明显改善患者临床症状体征,降低肝脏炎症,稳定肝功,快速抑制HBV复制,减少肿瘤的复发,为此拒绝抗病毒治疗的患者若进行抗病毒治疗将受益匪浅;有肝癌家族史的乙肝相关性原发性肝癌患者,女性抗病毒近期疗效优于男性。(3)药物类型、饮酒史、HBe Ag阳性、HBV DNA、块状型、组织学病理类型为HCC等因素是影响抗病毒疗效的独立影响因素,饮酒史、HBV DNA、块状型、HCC是危险因素,而药物类型是保护因素,HBe Ag阳性可能是保护因素。
[Abstract]:Objective: To observe the effect of antiviral therapy on the clinical indexes of HCC patients and objectively evaluate the effect of antiviral therapy in order to persuade the patients who refuse antiviral therapy to carry out antiviral therapy and to discuss the independent factors affecting the antiviral effect of HB related primary liver cancer patients and to treat the clinical treatment. Some theoretical and practical basis was provided for the treatment of such diseases. Methods: a retrospective analysis was made of the complete clinical data of the first diagnosis of HCC patients hospitalized in the Guangxi University of traditional Chinese medicine, Guangxi, June 2010, which was first diagnosed as hepatitis B related primary liver cancer, and 418 patients were selected according to the criteria and exclusion criteria. No antiviral therapy was used for the use of nucleoside (acid) analogues. Antiviral drugs were used for the first time. 238 cases of antiviral treatment were used as antiviral groups. 180 patients who refused antiviral treatment were used as control group. The related bed data and indicators in group two 3,6,12 months after treatment were compared, including sex, age, and history of individual smoking (smoking history). Family history, family history, antiviral drugs, major clinical symptoms and signs (liver pain, emaciation, jaundice, ascites), TBIL, ALB, ALT, AST, PT, AFP, HBe Ag, HBV DNA, Child-Pugh score, image classification (lump type, nodular), histological type (hepatocellular carcinoma HCC, intrahepatic bile duct hepatocellular carcinoma, mixed type). The main related factors of antiviral effect were analyzed, single factor Logistic regression analysis was carried out on the factors with significant differences, in order to control the interference of confounding factors, and then the independent factors influencing the effect of antiviral effect were screened out by multi factor unconditional Logistic regression analysis on the variables of P0.05 in single factor analysis. (1) among the 418 cases, there were 369 men and 49 women, and the proportion of men and women was 7.53:1; the average age was (45.68 + 12.08) years, 131 cases in 45~59 years, 31.34% and 228 cases, of which there were 228 cases at the age of 45, and there was no difference in the related clinical indexes of the first visit of the group of 12.72%. (2) in the population (P0.05); after 3,6 months of antiviral treatment, the antiviral group was compared with the control group. The pain relief rate, the remission rate of jaundice, the remission rate of the jaundice, the remission rate of the ascites, the time of PT shortening, the TBIL, ALB, ALT, AST, AFP, HBV DNA, Child-Pugh score, HCC, ICC and so on, were significantly improved (P0.05). After the antiviral treatment in December, the antivirus group was better than the control group, and the difference was statistically significant. The negative conversion rate of AFP (38.56 + 17.82) u g/L and HBV DNA was 89.50%, and the control group was (252.59 + 132.23) u g/L, 3.33%, and there was a significant difference (P0.05). There were 78 patients with family history of liver cancer in parallel with antiviral therapy. After 6 months of antivirus, the improvement of women in TBIL, ALT, AFP, HBV, and other scores were all superior to men, and the difference was statistically significant Significance (P0.05). (3) single factor Logistic regression analysis showed that drug types, drinking history, family history, jaundice, ascites, PT, HBe Ag positive, HBV DNA, Child-Pugh score, lump type, HCC entered the multifactor equation; multifactor non conditional Logistic regression analysis showed drug type (OR=5.376,95%CI 1.842~34.259), drinking history HBe Ag positive (OR=13.821,95%CI 4.217~45.292), HBV DNA (OR=0.534,95%CI 0.343~0.829), lump type (OR=5.424,95%CI 2.006~14.666), HCC (OR=13.546,95%CI) are the independent factors affecting the effect of antiviral effect. Conclusion: (1) most of the patients with HCC were significantly more male than women, but the majority of the patients were middle-aged, but the majority of the patients were middle-aged patients. The age of onset is obvious. (2) antiviral therapy for HCC patients can obviously improve the clinical symptoms and signs, reduce liver inflammation, stabilize the liver function, quickly inhibit HBV replication and reduce the recurrence of tumor. Patients with hepatitis B related primary liver cancer were better than men in the near future. (3) drug types, drinking history, HBe Ag positive, HBV DNA, massive type, and histologic type of HCC are independent factors affecting the antiviral effect, drinking history, HBV DNA, lump type, HCC are risk factors, and drug type is a protective factor, HBe A G positive may be a protective factor.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R735.7

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