目的 探讨无肝硬化乙肝相关肝癌患者的发病因素。方法 收集2004-01至2015-12月我院就诊的原发性肝癌共1000例。根据是否有肝硬化分为肝硬化组(n=934例)及无肝硬化组(n=66例),回顾性分析2组患者的一般情况及实验室检查指标等资料,对无肝硬化乙肝相关肝癌患者的发病因素进行χ2检验及Logistic回归分析。结果 单因素分析表明2组患者在年龄、是否饮酒、是否重叠丙型肝炎病毒感染、是否合并高血压、基线血清e抗原状态及血清HBV DNA水平、是否行抗病毒治疗与是否有肝癌家族史方面差异有统计学意义(P<0.05);将其纳入多因素非条件Logistic回归分析,结果提示饮酒(OR=0.176,P=0.002)、有高血压病史(OR=0.505,P=0.039)、基线血清HBV DNA水平偏低(OR=0.031,P＜0.001)、既往未行抗病毒治疗(OR=7.268,P＜0.001)、有肝癌家族史(OR=0.487,P=0.010)是无肝硬化慢性乙型肝炎患者直接进展为原发性肝癌的独立危险因素。结论 对于有饮酒史、有高血压病史、基线血清HBV DNA水平偏低、既往未行抗病毒治疗及有肝癌家族史的无肝硬化慢性乙型肝炎患者,应密切监测肝癌的发生。
Abstract
Objective To investigate the risk factors of hepatitis B virus related hepatocellular carcinoma patients without cirrhosis.Methods A total of one thousand hepatocellular carcinoma patients were collected between January 2004 and December 2015-at Shanghai Corps Hospital of Chinese People’s Armed Police Force. The patients were divided into cirrhosis(n=934) group and non-cirrhosis(n=66) group according to whether there was cirrhosis of the liver. The general information and indexes of laboratory examination in both groups were analyzed retrospectively. χ2 test and Logistic regression analysis were performed on the risk factors of hepatitis B virus related hepatocellular carcinoma patients without cirrhosis.Results The univariate analysis indicated that the difference in age, drinking of alcohol, overlap of hepatitis C virus infection, combination with hypertension, baseline serum e antigen status and serum HBV DNA levels, previous antiviral therapy and the family history of liver cancer were statistically significant between the two groups(P<0.05). The multivariate non-conditioned Logistic regression analysis of these eight factors indicated that drinking of alcohol(OR=0.176,P=0.002), combination with hypertension(OR=0.505,P=0.039), lower baseline serum HBV DNA levels (OR=0.031,P＜0.001), previous antiviral therapy (OR=7.268,P＜0.001) and the family history of liver cancer(OR=0.487,P=0.010) were independent risk factors which induce chronic hepatitis B to directly develop into hepatocellular carcinoma without cirrhosis.Conclusions Drinking of alcohol, combination with hypertension, low baseline serum HBV DNA levels, no previous antiviral therapy and the family history of liver cancer patients are possibly associated with the occurrence of hepatocellular carcinoma.
关键词
乙型肝炎 /
肝癌 /
肝硬化 /
影响因素
Key words
hepatitis B /
hepatocellular carcinoma /
cirrhosis /
influence factor
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