近年肝癌患者临床特征及预后影响因素研究

发布时间：2018-05-06 18:13

本文选题：原发性肝癌 + 回顾性流行病学　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:通过对我院诊断为原发性肝癌住院患者的病历资料收集及数据分析,了解近年来原发性肝癌患者的临床特征和预后影响因素。方法:回顾性流行病学调查:首先通过计算机检索我院在2014年10月1日-2016年9月30日住院的原发性肝癌(Primary liver cancer,PLC)患者277例,查阅其住院病历,登记有关指标:人口学资料、特殊不良嗜好、既往病史、肿瘤病理学特征、影像学结果等相关资料,探索近年流行病学特征情况以及预后影响因素的组成,用描述性统计学方法对研究结果进行描述,借SPSS19.0软件进行数据处理,以P0.05为显著差异。结果:1.277例肝癌患者中,男性患者有215例,女性相对较少为62例,男:女=3.47:1。2.肝癌患者中:HBV感染者197例(71.1%),HCV感染者21例(7.5%),17例(6.1%)有可疑用药史,酒精性肝病者7例(2.5%),HBV/HCV感染占1例,HBV/酒精性肝病2例,自身免疫性肝癌占1例,其他原因相关性肝癌患者占31例。3.合并症:肝硬化病史者184例,肝炎患者39例,高血压43例、糖尿病40例、冠心病5例。4.肝癌初治患者中,AFP(200ng/ml)阳性率42%。5.乙肝血清学标志:HBsAg、HBeAb及HBcAb阳性者71例(39.0%);HBsAg和HBc Ab阳性48例(24.3%);HBsAg、HBeAg及HBcAb阳性21例(10.6%);其余类型占28.9%。6.肝癌诊断前HBV感染者行抗HBV治疗有30例(15.3%),治疗后转阴的有22例,未进行抗病毒治疗的有166例(84.6%),HCV感染患者有抗病毒病史的3例(15%),行抗病毒治疗后病毒均为阴性,未进行抗病毒治疗的有17例(85%)。7.初次诊断肝癌213例,单发109例(51.2%),多发89例(41.7%),单叶累及肝右叶111例(52.1%),肝左叶47例(22.0%),尾状叶5例(2.3%),肝门6例(2.8%),累及两肝叶以上38例(17.8%)。8.肝功能级别、BMI、BCLC期次,癌组织大小、甲胎蛋白、有无肝硬化是影响患者生存期的单因素。9.BMI、BCLC分期、肝硬化、肿瘤大小是影响肝癌患者生存期独立因素,其中BMI是保护因素,BCLC期次、肝硬化、肿瘤大小是危险因素。10.对于有治疗指征患者,综合治疗组12月、36月和60月存活率均高于介入组,综合治疗组生存时间长于单纯TACE组。结论:1.我省近年来原发性肝癌,男性患病所占比例高,HBV感染为其主要病因,其次为药物性肝损害、HCV感染、饮酒、其他因素等。2.初发肝癌患者肿瘤多为单发,肝右叶累积较多。3.肝癌初治患者中,AFP(200 ng/ml)阳性率44%,预测诊断肝癌有一定局限性,需探究覆盖面更广的标志物。4.HBV病毒复制与肝癌发生关系:对于大多数肝癌患者虽然病毒复制呈现稳定状态,病毒血清学示HBe Ab阳转者,甚至HBsAg转阴者、HBVDNA阴性,仍有发生肝癌的可能,因此对于HBV相关性的肝癌,提倡早期抗病毒治疗,减少HBV整合等机会,避免导致肝癌发生。5.对于肝癌患者,保持良好营养状态,防止肝功能失代偿,控制瘤体增长,有肝硬化者积极抗肝纤维化治疗,可有效延长患者生存期。6.对于有治疗指征肝癌患者,综合治疗方案能有效提高患者存活率。
[Abstract]:Objective: to study the clinical features and prognostic factors of patients with primary liver cancer (HCC) in recent years by collecting and analyzing the medical records of patients with primary liver cancer (PHC) diagnosed in our hospital. Methods: a retrospective epidemiological survey was conducted. First, 277 patients with primary liver cancer in our hospital from October 1, 2014 to September 30, 2016 were searched by computer. Special bad habits, past medical history, tumor pathological features, imaging results and other relevant data, the epidemiological characteristics in recent years and the composition of prognostic factors were explored. Descriptive statistics were used to describe the results of the study. SPSS19.0 software for data processing, P0.05 as a significant difference. Results of the 1. 277 HCC patients, 215 were male and 62 were females. Male: female: 3. 47: 1. 2. Of the 197 patients with hepatocellular carcinoma, 197 were infected with HBV and 21 were infected with HCV (7.5and 17 / 6.1), 7 patients with alcoholic liver disease accounted for 1 HBV / alcoholic liver disease, 1 patient was autoimmune liver cancer, and 31 patients with other related liver cancer were found to have a history of drug use, among them 7 patients with alcoholic liver disease accounted for 1 patient with HBV / alcoholic liver disease, 1 patient with autoimmune liver cancer, and 31 patients with liver cancer associated with other causes. Complications: 184 cases of liver cirrhosis, 39 cases of hepatitis, 43 cases of hypertension, 40 cases of diabetes, 5 cases of coronary heart disease. The positive rate of AFP 200 ng / ml in patients with primary liver cancer was 42. 5%. There were 71 cases (39.0%) with HBeAb and HBcAb positive in hepatitis B serological marker. There were 48 cases with positive HBsAg and HBc Ab in 48 cases and 21 cases with HBeAg positive and HBcAb positive in 21 cases, and the rest type accounted for 28.9%. Before diagnosis, 30 patients with HBV infection were treated with anti-HCV therapy, 22 patients turned negative after treatment, and 3 patients without antiviral therapy had a history of antiviral infection. All of them were negative after antiviral therapy. There were 17 cases without antiviral therapy. There were 213 cases of primary diagnosis of liver cancer, 109 cases of primary hepatic carcinoma and 51.2% of carcinoma, 89 cases of which were 41.7%, 111 cases of single lobe involved right lobe of liver, 47 cases of hepatic Zuo Ye were involved in right lobe of liver, 47 cases were involved in 22.0 cases, 5 cases of caudate lobe were involved with 2.3T, 6 cases of hilum of liver were 2.8B, and 38 cases were above two lobes of liver. Liver function grade BMI-BCLC stage, cancer tissue size, alpha-fetoprotein, liver cirrhosis are the single factors that affect the survival of patients. Liver cirrhosis, tumor size is an independent factor affecting the survival of patients with liver cancer, among which BMI is the protective factor of BCLC stage. Liver cirrhosis, tumor size is a risk factor. 10. For patients with indications of treatment, the survival rate of the combined treatment group was higher than that of the interventional group in 12 months, 36 months and 60 months, and the survival time of the combined treatment group was longer than that of the simple TACE group. Conclusion 1. In recent years, the primary liver cancer in our province is mainly caused by high incidence of HBV infection in males, followed by HCV infection with drug induced liver damage, alcohol consumption, other factors and so on. 2. Primary liver cancer patients are mostly single tumor, liver right lobe accumulation is more. 3. The positive rate of AFP 200 ng / ml in patients with primary liver cancer is 44%. Prediction of liver cancer has some limitations. It is necessary to explore the relationship between HBV virus replication and liver cancer occurrence. 4. For most patients with liver cancer, although virus replication shows a stable state, it is necessary to explore the relationship between HBV virus replication and liver cancer occurrence. Virus serology showed that HBe Ab positive conversion, or even HBsAg negative, still had the possibility of developing liver cancer. Therefore, early antiviral therapy should be advocated to reduce the chance of HBV integration so as to avoid the occurrence of hepatoma. For patients with liver cancer, maintaining good nutritional status, preventing decompensation of liver function, controlling tumor growth, and active anti-hepatic fibrosis treatment in patients with liver cirrhosis can effectively prolong the survival time of patients. For patients with liver cancer, comprehensive therapy can effectively improve the survival rate.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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