肝癌与糖尿病相关性的临床研究

发布时间：2018-07-05 21:00

本文选题：肝癌 + 糖尿病　；参考：《新乡医学院》2017年硕士论文

【摘要】：目的探究肝癌与糖尿病的相关性,分析糖尿病在肝癌的发生、肝癌伴HBV感染患者的治疗、肝癌转移过程中产生的不良影响,为有效预防肝癌的发生,避免糖尿病对肝癌患者产生的不良影响,提升肝癌患者的整体治疗效果,改善预后提供科学指导。方法本研究选择2013年1月至2014年1月在我院接受治疗的70例糖尿病合并肝癌患者和70例单纯肝癌患者为研究对象,将其设置为糖尿病组和非糖尿病组,回顾分析所有患者相关临床资料信息。首先分析两组患者一般资料的差异性,探究糖尿病对肝癌发生发展的整体影响;然后以两组中的HBV感染和HCV感染患者为研究对象,分析糖尿病对HBV感染和HCV感染肝癌患者的影响;最后以两组中采用手术治疗的患者为研究对象,对比分析两组患者的病理组织中NF-kBP65、pSTAT3/STAT3、NCOA5、CD34阳性表达情况,探究糖尿病对肝癌转移的影响。在研究过程中,关于患者的结果相关数据使用SPSS21.0统计学软件进行处理,计数单位和计量单位分别使用(%)和(±s)表示,对数据比较结果采用X2、t进行检验,如果得出P0.05,则该研究数据比较具有统计学意义。在此基础上采用Pearson相关分析对糖尿病与肝癌患者各项观察指标之间的相关性进行研究,若P0.05,表示相关性较强。结果1.从整体分析来看,糖尿病组患者的年龄、肿瘤大小、合并有HBV感染和HCV感染患者百分比、BCLC分期中处于进展期和终末期患者的百分比、门静脉癌栓形成患者的百分比、发生消化道出血患者的百分比、发生病灶转移的患者百分比均明显高于非糖尿病组;而糖尿病组患者的生存期明显低于非糖尿病组;以上各项指标比较差异均显著,(P0.05),具有统计学意义。两组患者在性别方面比较差异不显著,(P0.05),不具有统计学意义。将糖尿病与肝癌患者年龄、HBV感染、HCV感染、BCLC分期、门静脉癌栓、消化道出血、病灶转移、生存期之间的相关性进行分析,研究发现糖尿病与肝癌患者的BCLC分期、门静脉癌栓、消化道出血、病灶转移、生存期之间关系密切,(P0.05)。2.对两组中伴有HBV感染且仅采用TACE方法治疗的患者进行对比分析,糖尿病组患者中有48(68.57%)例,非糖尿病组中有25(35.71%)例。治疗前,糖尿病组患者的白蛋白(ALB)水平明显低于非糖尿病组,凝血酶原时间(PT时间)明显高于非糖尿病组;从整体来看糖尿病组患者的Child-Pugh评分及分级明显高于非糖尿病组,比较差异均显著,(P0.05)。而两组患者在丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)等指标方面比较差异不显著,(P0.05),不具有统计学意义。治疗后,糖尿病组患者的ALB、PT时间、Child-Pugh评分及分级、TBIL等指标均明显高于非糖尿病组,而在ALT和AST两项指标方面比较差异不显著,(P0.05),不具有统计学意义。将糖尿病与肝功能各项指标之间的相关性进行分析,发现糖尿病与肝癌患者的Child-Pugh评分关系密切,P0.05。3.对两组患者中单纯采用手术方法治疗的患者进行对比研究分析,对比分析两组患者病理组织中NF-kBP65、pSTAT3/STAT3、NCOA5、CD34表达情况,糖尿病组患者的病理组织中NF-kBP65、pSTAT3/STAT3、CD3阳性表达率情况平明显高于非糖尿病组,而NCOA5阳性表达则明显低于非糖尿病组,两组之间比较差异显著,(P0.05),有统计学意义。将糖尿病与NF-kBP65、pSTAT3/STAT3、NCOA5、CD34阳性表达之间的相关性进行分析,研究发现糖尿病与各项病理指标阳性表达之间的关系密切,(P0.05)。结论糖尿病与肝癌的发生发展密切相关,是肝癌发生、发展的重要危险因素,可能加重患者的病情分期,引发肝癌病灶转移、门静脉侵犯、消化道出血,导致HBV感染肝癌患者预后不良,诱发肝癌发展。在临床当中要关注糖尿病患者,防止其引发肝癌,对于糖尿病肝癌患者要予以针对性治疗,并密切关注患者的病情发展情况,以控制病情,提升患者的预后水平。
[Abstract]:Objective to explore the correlation between liver cancer and diabetes, to analyze the adverse effects of diabetes in the occurrence of liver cancer, the treatment of the patients with HBV infection and the metastasis of liver cancer, to prevent the occurrence of liver cancer effectively, to avoid the adverse effects of diabetes on the patients with liver cancer, to improve the overall therapeutic effect and to improve the prognosis of the liver cancer patients. Methods 70 cases of diabetes combined with liver cancer and 70 patients with simple liver cancer in our hospital from January 2013 to January 2014 were selected as the subjects of the study. They were set up in the diabetes group and non diabetic group. The clinical information of all the patients was reviewed and analyzed. First, the difference of the general data of the two groups was analyzed. To explore the overall effect of diabetes on the development and development of liver cancer, and then to analyze the effect of diabetes on HBV infection and HCV infected patients with liver cancer in two groups of HBV infection and HCV infection. Finally, the patients in the two groups who were treated with surgical treatment were compared and analyzed in the pathological tissue of two groups of patients, NF-kBP65, pSTAT3/STA T3, NCOA5, CD34 positive expression, explore the effect of diabetes on the metastasis of liver cancer. In the course of the study, the data related to the outcome of the patients were treated with SPSS21.0 statistics software, and the counting units and measurement units were used (%) and (+ s) respectively, and the results were tested by X2 and t. If P0.05 was obtained, the study was made. The data were statistically significant. On this basis, Pearson correlation analysis was used to study the correlation between the various observation indexes of diabetes and liver cancer. If P0.05, the correlation was stronger. Results 1. from the overall analysis, the age of the patients in the diabetic group, the size of the tumor, the percentage of HBV infection and HCV infection, B The percentage of patients with advanced and end-stage CLC staging, the percentage of patients with portal vein thrombosis, the percentage of patients with gastrointestinal bleeding, and the percentage of patients with metastatic lesions were significantly higher than those in the non diabetic group, while the survival time of the diabetic group was significantly lower than that in the non diabetic group; the above indexes were all the difference in all the patients. Significant, (P0.05), with statistical significance. There was no significant difference in sex between the two groups. (P0.05), there was no statistical significance. The correlation between diabetes and liver cancer patients' age, HBV infection, HCV infection, BCLC staging, portal vein thrombus, digestive tract bleeding, lesion shift, survival time was analyzed, and diabetes and liver cancer were found. BCLC staging, portal vein thrombus, gastrointestinal bleeding, metastasis, and survival time were closely related, and (P0.05).2. was compared in two groups of patients with HBV infection and only treated with TACE, in the diabetic group, 48 (68.57%), and 25 (35.71%) in the non diabetic group. (ALB) was significantly lower than non diabetic group and prothrombin time (PT time) was significantly higher than that in non diabetic group. The Child-Pugh score and classification of patients with diabetes were significantly higher than those in non diabetic group (P0.05), and the two groups were in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBI). L) and other indicators, the difference was not significant, (P0.05), no statistical significance. After treatment, the ALB, PT time, Child-Pugh score and classification, TBIL of the diabetic group were significantly higher than those in the non diabetic group, but there was no significant difference between the two indexes of ALT and AST, (P0.05), not statistically significant. The correlation between the indexes was analyzed, and the Child-Pugh score of the patients with diabetes and liver cancer was closely related. P0.05.3. was compared and analyzed in the two groups of patients who were treated with surgical methods alone. The expression of NF-kBP65, pSTAT3/STAT3, NCOA5, CD34 in the pathological tissues of the two groups was compared and analyzed, and the patients in the diabetic group were compared and analyzed. The positive expression of NF-kBP65, pSTAT3/STAT3 and CD3 in the pathological tissue was significantly higher than that in the non diabetic group, while the positive expression of NCOA5 was significantly lower than that in the non diabetic group. The difference was significant between the two groups, (P0.05), and the correlation between the positive expression of diabetes and NF-kBP65, pSTAT3/ STAT3, NCOA5 and CD34 was analyzed. It is found that diabetes is closely related to the positive expression of various pathological indexes, (P0.05). Conclusion diabetes is closely related to the development and development of liver cancer. It is an important risk factor for the development of liver cancer. It may aggravate the stage of the patient's disease, cause the metastasis of the liver cancer, the invasion of the portal vein, the hemorrhage of the digestive tract, and lead to the preconditioning of the patients with HBV infection of the liver cancer. In the clinical, we should pay attention to the patients with diabetes, prevent it from causing liver cancer, to treat the patients with diabetes and liver cancer, and pay close attention to the development of the patient's condition in order to control the condition and improve the prognosis of the patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R587.1

【参考文献】