慢性乙型和丙型病毒性肝炎合并原发性肝癌的相关因素研究

发布时间：2018-05-28 16:59

本文选题：原发性肝癌 + 乙型肝炎病毒　；参考：《中国疾病预防控制中心》2017年硕士论文

【摘要】：目的调查分析慢性乙型肝炎和丙型肝炎合并原发性肝癌的相关因素,为降低慢性肝炎发展肝癌,提高慢性肝炎患者生存与生命质量提供依据。同时利用所选定医院的病案信息管理系统,分析原发性肝癌中乙型肝炎和丙型肝炎的比例及可能变化趋势。方法本研究分为横断面研究和既往病历资料分析。横断面研究:选取符合调查要求的慢性乙型肝炎和慢性丙型肝炎作为研究对象,问卷调查内容包括患者的人口学特征、生活习惯、肝炎及肝癌诊治情况和其它疾病。根据临床诊断分别将慢性乙型和丙型肝炎分为慢性肝炎组(即未发展为肝癌分为慢性乙型肝炎组和慢性丙型肝炎组)和原发性肝癌组。采用单因素和多因素非条件logistic回归分析慢性乙型和丙型肝炎合并肝癌的相关因素。既往病历资料分析:将指定医院2011-2015年的原发性肝癌患者作为研究对象。根据入院日期的年份计算每年肝癌患者中乙型肝炎、丙型肝炎比例,及构成比例的变化趋势。结果横断面调查:本研究共收集有效问卷609份。其中慢性乙型肝炎480例,根据临床诊断分为慢性乙型肝炎组275例,原发性肝癌组205例。慢性丙型肝炎129例,根据临床诊断分为慢性丙型肝炎组102例,原发性肝癌组27例。调查结果如下:1.慢性乙型肝炎(n=480)和慢性丙型肝炎(n=129)年龄和性别比较:慢性丙型肝炎年龄大于慢性乙型肝炎(t=5.27,P0.001)。慢性乙型肝炎男性比例高于慢性丙型肝炎(χ2=19.66,P0.001)。2.慢性乙型肝炎合并肝癌的相关因素:单因素分析显示,受教育程度、鱼摄入、脂肪肝、高血脂的结果无统计学意义(P0.05)。年龄、性别、户籍所在地、职业性体力活动、饮酒、吸烟、绿茶摄入、咖啡摄入、抗病毒治疗、糖尿病、肝癌家族史结果有统计学意义(P0.05)。抗病毒治疗年限有剂量反应关系,抗病毒治疗10年和≥10年的OR值分别为0.22(0.15～0.33)和0.14(0.03～0.65),χ2趋势有统计学意义(χ2=58.02,P0.001)。多因素分析显示,绿茶摄入(OR=0.39,95%CI:0.20～0.77)、抗病毒治疗(OR=0.18,95%CI:0.11～0.31)与慢性乙型肝炎合并肝癌呈负相关。男性(OR=3.55,95%CI:1.73～7.25)、户籍地在农村(OR=2.38,95%CI:1.25～4.55)、饮酒(OR=2.00,95%CI:1.04～3.85)、肝癌家族史(OR4.08,95%CI:2.18～7.65)与慢性乙型肝炎合并肝癌呈正相关。3.慢性丙型肝炎合并肝癌的相关因素:单因素分析显示,户籍所在地、职业性体力活动、吸烟、绿茶摄入、咖啡摄入、鱼摄入、脂肪肝、高血脂、糖尿病、肝癌家族史结果无统计学意义(P0.05)。年龄、性别、饮酒、抗病毒治疗结果有统计学意义(P0.05)。多因素分析显示,抗病毒治疗(OR=20,95%CI:0.06～0.66)与慢性丙型肝炎合并肝癌呈负相关。年龄≥55岁(OR=5.23,95%CI:1.72～15.92)、饮酒(OR=3.34,95%CI:1.04～10.74)与慢性丙型肝炎合并肝癌呈正相关。既往病历资料分析:4569例原发性肝癌患者,平均年龄55.4岁,男性3694例(占80.8%)。分析结果如下:1.年龄和性别分布:男性肝癌患者平均年龄小于女性肝癌患者(F=78.31,P0.001)。乙型肝炎合并肝癌患者平均年龄小于丙型肝炎合并肝癌患者(F=269.42,P0.001)。乙型肝炎合并肝癌患者男性比例高于丙型肝炎合并肝癌患者(χ2=65.18,P0.001)。2.HBV和HCV感染比例及变化:2011-2015年肝癌的HBV感染比例为71.6%,HCV感染比例为5.2%。男性肝癌中HBV感染比例为75.0%,女性肝癌HBV感染比例为57.5%,男性HBV感染比例高于女性(χ2=106.63,P0.001)。男性肝癌中HCV感染比例为4.2%,女性肝癌中HCV感染比例为9.7%,女性HCV感染比例高于男性(χ2=43.88,P0.001)。但均没有出现明显的变化趋势。结论横断面研究提示,抗病毒治疗可能利于延缓肝癌的发生,饮酒可能增加罹患肝癌的风险。建议慢性乙型肝炎和丙型肝炎患者,戒酒并在医生指导下及早和坚持开展抗病毒治疗;同时有肝癌家族史的乙型患者和高年龄的丙型肝炎患者应注意定期进行医学监测和随访,早期发现肝癌。既往病历资料分析显示,我国肝癌以乙型肝炎感染居多。肝癌的HBV和HCV感染构成比例基本平稳,没有出现明显的变化趋势。肝癌患者平均年龄男性低于女性,可能与男性生活习惯(如饮酒)及激素水平等因素有关。乙型肝炎合并肝癌男性比例高于丙型肝炎合并肝癌,乙型肝炎合并肝癌平均年龄低于丙型肝炎合并肝癌,可能与乙型肝炎与丙型肝炎的感染年龄有关。
[Abstract]:Objective to investigate and analyze the related factors of chronic hepatitis B and HCV combined with primary liver cancer, and to provide the basis for reducing the development of liver cancer and improving the survival and quality of life of chronic hepatitis. The study is divided into cross-sectional study and previous medical record data analysis. Cross sectional study: select the chronic hepatitis B and chronic hepatitis C as the research object. The questionnaire includes the demographic characteristics of the patients, the living habits, the diagnosis and treatment of hepatitis and liver cancer and other diseases. Chronic hepatitis B and C were divided into chronic hepatitis B group (chronic hepatitis B group and chronic hepatitis C group) and primary liver cancer group, respectively. A single factor and multiple factor non conditional logistic regression analysis were used to analyze the related factors of chronic hepatitis B and HCV with HCC. 2011-2015 years of primary liver cancer in the designated hospital were used as the research object. According to the date of admission, the proportion of hepatitis B, hepatitis C and the proportion of HCV were calculated every year. Results the cross-sectional survey: a total of 609 effective questionnaires were collected in this study. 480 cases of chronic hepatitis B were diagnosed according to clinical diagnosis. 275 cases of chronic hepatitis B, 205 cases of primary liver cancer and 129 cases of chronic hepatitis C, 102 cases of chronic hepatitis C and 27 cases of primary liver cancer were divided according to clinical diagnosis. The results were as follows: 1. the age and sex of chronic hepatitis B (n=480) and chronic hepatitis C (n=129): the age of chronic hepatitis C is greater than that of chronic hepatitis B T=5.27 (P0.001). The proportion of men with chronic hepatitis B is higher than that of chronic hepatitis C (x 2=19.66, P0.001).2. with chronic hepatitis B combined with liver cancer: univariate analysis showed that education, fish intake, fatty liver, and hyperlipidemia were not statistically significant (P0.05). Age, sex, residence, occupational physical activity, drinking Wine, smoking, green tea intake, coffee intake, antiviral therapy, diabetes, and liver cancer family history were statistically significant (P0.05). Antiviral treatment years had a dose response relationship. The OR values of antiviral treatment for 10 years and more than 10 years were 0.22 (0.15 to 0.33) and 0.14 (0.03 to 0.65), and the chi chi 2 trend was statistically significant (x 2=58.02, P0.001). Analysis showed that green tea intake (OR=0.39,95%CI:0.20 ~ 0.77), antiviral therapy (OR=0.18,95%CI:0.11 ~ 0.31) had negative correlation with chronic hepatitis B combined with liver cancer. Male (OR=3.55,95%CI:1.73 to 7.25), household registration area in rural (OR=2.38,95%CI:1.25 to 4.55), drinking (OR= 2.00,95%CI:1.04 ~ 3.85), family history of liver cancer (OR4.08,95%CI:2.18 to 7.65) and slow The related factors of.3. chronic hepatitis C and HCC were positively correlated with HBV and HCC: single factor analysis showed that the family history of household registration, occupational physical activity, smoking, green tea intake, coffee intake, fish intake, fatty liver, hyperlipidemia, diabetes, and liver cancer had no statistical significance (P0.05). Age, sex, drinking, antiviral The results of the treatment were statistically significant (P0.05). The multifactor analysis showed that antiviral therapy (OR=20,95%CI:0.06 ~ 0.66) had a negative correlation with chronic hepatitis C combined with liver cancer. The age was more than 55 years old (OR=5.23,95%CI:1.72 to 15.92), and drinking (OR=3.34,95%CI:1.04 ~ 10.74) was positively correlated with HCC with chronic hepatitis C. The analysis of previous medical records: 4569 The average age of the patients with primary liver cancer was 55.4 years and 3694 men (80.8%). The results were as follows: 1. age and sex distribution: the average age of male patients with liver cancer was less than that of women with liver cancer (F=78.31, P0.001). The average age of hepatitis B combined with liver cancer was less than that of hepatitis C and liver cancer (F=269.42, P0.001). The proportion of men with liver cancer was higher than that of hepatitis C and HCC (x 2=65.18, P0.001).2.HBV and HCV infection: the proportion of HBV infection in 2011-2015 years of liver cancer was 71.6%, the proportion of HCV infection in 5.2%. male liver cancer was 75%, the proportion of HBV infection in female liver cancer was 57.5%, and the ratio of HBV infection in male was higher than that of women (chi 2=106.63). P0.001). The proportion of HCV infection in male liver cancer is 4.2%, the proportion of HCV infection in female liver cancer is 9.7%, the proportion of female HCV infection is higher than that of male (x 2=43.88, P0.001). But no obvious change trend is found. Conclusion cross sectional study suggests that antiviral therapy may help delay the occurrence of liver cancer, and drinking may increase the risk of liver cancer. For patients with chronic hepatitis B and hepatitis C, abstinence and early and insistence on antiviral treatment under the guidance of doctors; at the same time, patients with family history of liver cancer and high age hepatitis C patients should pay attention to regular medical monitoring and follow-up and early detection of liver cancer. Analysis of previous medical records shows that hepatitis B in China is hepatitis B The proportion of HBV and HCV infection in liver cancer is basically stable, and there is no obvious trend of change. The average age of the patients with liver cancer is lower than that of women. It may be related to the male living habits (such as drinking) and hormone levels. The proportion of HBV combined with liver cancer is higher than that of HCV with HCC, HBV combined with liver cancer. The average age is lower than that of hepatitis C, which may be related to the age of infection of hepatitis B and hepatitis C.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.6;R735.7

【相似文献】