接受抗病毒治疗的代偿期乙肝肝硬化患者进展为肝癌的危险因素分析

发布时间：2018-03-29 12:12

  本文选题：乙型病毒性肝炎　切入点：肝硬化　出处：《山东医药》2017年32期

【摘要】：目的探讨接受抗病毒治疗的代偿期乙肝肝硬化患者进展为肝细胞癌(肝癌)的危险因素。方法收集抗病毒治疗至少12个月的代偿期乙肝肝硬化患者95例,根据其是否进展为肝癌分为肝癌组16例和非肝癌组79例。收集并比较两组临床资料,包括性别、年龄、肝癌家族史、病毒学应答(抗病毒治疗6个月时HBV DNA测不出)情况、核苷(酸)类似物耐药情况,以及抗病毒治疗前HBe Ag定性检查结果、血清HBV DNA的log10、血清天门冬氨酸氨基转移酶(AST)、血清白蛋白、血小板计数。以两组间比较差异有统计学意义的资料为自变量,以进展为肝癌为因变量,对自变量分别赋值进行COX回归模型分析,确定进展为肝癌的危险因素。结果两组抗病毒治疗前血清AST水平、抗病毒治疗前血清白蛋白水平、肝癌家族史、核苷(酸)类似物耐药构成比比较P均0.05,两组年龄及性别男、抗病毒治疗前HBe Ag阳性、病毒学应答构成比、抗病毒治疗前血清HBV DNA的log10、抗病毒治疗前血小板计数比较P均0.05。上述4项有意义的指标纳入多因素COX回归分析结果显示,抗病毒治疗前血清AST水平的HR为12.05,95%CI为2.65~55.56,P=0.001;抗病毒治疗前血清白蛋白水平的HR为1.10,95%CI为0.95~1.27,P=0.201;肝癌家族史的HR为3.51,95%CI为0.80~15.41,P=0.096;核苷(酸)类似物耐药的HR为5.71,95%CI为1.31~24.83,P=0.020。结论抗病毒治疗前血清AST水平升高和核苷(酸)类似物耐药是接受抗病毒治疗的代偿期乙肝肝硬化患者进展为肝癌的危险因素。
[Abstract]:Objective to investigate the risk factors of progression to hepatocellular carcinoma (HCC) in patients with compensatory hepatitis B cirrhosis treated with antiviral therapy. Methods 95 patients with compensatory hepatitis B cirrhosis treated with antiviral therapy for at least 12 months were collected. According to its progression, HCC was divided into HCC group (n = 16) and non-HCC group (n = 79). The clinical data of the two groups were collected and compared, including sex, age, family history of liver cancer, virological response (HBV DNA could not be measured at 6 months after antiviral therapy). The drug resistance of nucleoside (acid) analogue, and the qualitative examination of HBe Ag before antiviral therapy, the log10 of serum HBV DNA, the aspartate aminotransferase of aspartate, the serum albumin, Platelet count. Taking the data with statistical significance as independent variable and progression as dependent variable, the independent variables were assigned by COX regression model. Results Serum AST level, serum albumin level before antiviral therapy, family history of liver cancer, ratio of drug resistance to nucleoside analogues were all 0.05 in the two groups (P < 0.05). Before antiviral therapy, HBe Ag was positive, virological response ratio, log10 of serum HBV DNA and platelet count before antiviral therapy were all P 0.05. The results of multivariate COX regression analysis showed that the above four significant indexes were included in multivariate COX regression analysis. Before antiviral therapy, the HR of serum AST level was 12.05% 95 CI was 2.65% 55.56% P0. 001; before antiviral therapy, the HR of serum albumin level was 1.1095% CI was 0.951.27% P0. 201; the family history of liver cancer was 3.51% 95% CI was 0.8015.41% P0. 096; the HR of nucleoside (acid) analogues was 5.71 95 CI was 1. 31% 24. 83% P0. 020. Conclusion the HR of family history of liver cancer is 0. 8015. 41P0. 096; the HR of nucleoside (acid) analogues is 5. 71% 95% CI is 1. 31% 24. 83% P0. 020.Conclusion the HR of family history of liver cancer is 0. 8015. 41. Elevated serum AST levels and resistance to nucleoside (acid) analogues are risk factors for progression to liver cancer in patients with compensatory hepatitis B cirrhosis treated with antiviral therapy.
【作者单位】： 山东大学第二医院;
【基金】：山东省科技发展计划项目(2016031710)
【分类号】：R512.62;R575.2;R735.7
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本文编号：1681083