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[应用aMAP评分评估基层医院慢性肝病患者肝癌发生风险]

[Application of aMAP score to assess the risk of hepatocarciongenesis in population of chronic liver disease in primary hospitals].

作者信息

Li X H, Hao X, Deng Y H, Liu X Q, Liu H Y, Zhou F Y, Fan R, Guo Y B, Hou J L

机构信息

Department of Infectious Diseases, Health Screening Center, The People's Hospital of Yudu County, Gangzhou 342300, China.

Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangzhou 510515, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2021 Apr 20;29(4):332-337. doi: 10.3760/cma.j.cn501113-20210329-00144.

Abstract

The aMAP score is a hepatocellular carcinoma (HCC) risk prediction model based on an international cooperative cohort, which can be applied to various liver diseases. The aim of this study is to use the aMAP score to stratify the risk of HCC in patients with chronic liver disease (combined or non-combined metabolic diseases) admitted to People's Hospital of Yudu County, Ganzhou City, Jiangxi Province, in order to guide personalized HCC screening. The demographic information, laboratory test results (platelets, albumin, and total bilirubin) and combined disease information of patients with chronic liver disease who were admitted to People's Hospital of Yudu from January 2016 to December 2020 were collected, and the aMAP score was calculated to stratify HCC risk in this population. A total of 3629 cases with chronic liver disease were included in the analysis, including 3 452 (95.1%) cases with hepatitis B virus (HBV) infection, 177 (4.9%) cases with fatty liver, and 22 (0.6%) cases with HBV infection and fatty liver. There were 2 679 (73.8%) male and the median age was 44 (35, 54). In the overall population, low, medium and high risk of HCC accounted for 52.6%, 29.0%, and 18.4% respectively. In the HBV-infected population, the proportion of high risk of HCC was significantly higher than that of fatty liver (18.9% vs. 9.6%, = 0.001). The proportion of chronic liver disease patients with combined hypertension or diabetes was significantly higher than that of those with non-combined metabolic diseases (combined hypertension: 32.3% vs. 17.9%, < 0.001; combined diabetes: 36.5% vs. 18.1%, < 0.001). Moreover, the proportion of high-risk population with two metabolic diseases was significantly higher than that with one and no metabolic diseases (40.9% vs. 31.8% vs. 17.7%, < 0.001). The aMAP score can be used as a simple tool for HCC screening and management of chronic liver disease in primary hospitals, and it is helpful to improve the personalized follow-up management system of chronic liver disease population. Chronic liver disease patients with metabolic diseases have a higher risk of HCC, and people with high risk of HCC should be given special priority in follow-up visits, so as to improve the rate of HCC early diagnosis and reduce the mortality rate.

摘要

aMAP评分是一种基于国际合作队列的肝细胞癌(HCC)风险预测模型,可应用于各种肝脏疾病。本研究的目的是使用aMAP评分对江西省赣州市于都县人民医院收治的慢性肝病(合并或未合并代谢性疾病)患者的HCC风险进行分层,以指导个性化的HCC筛查。收集了2016年1月至2020年12月在于都县人民医院住院的慢性肝病患者的人口统计学信息、实验室检查结果(血小板、白蛋白和总胆红素)以及合并疾病信息,并计算aMAP评分以对该人群的HCC风险进行分层。分析共纳入3629例慢性肝病患者,其中3452例(95.1%)为乙型肝炎病毒(HBV)感染,177例(4.9%)为脂肪肝,22例(0.6%)为HBV感染合并脂肪肝。男性2679例(73.8%),中位年龄为44岁(35,54)。在总体人群中,HCC低、中、高风险分别占52.6%、29.0%和18.4%。在HBV感染人群中,HCC高风险比例显著高于脂肪肝人群(18.9%对9.6%,P = 0.001)。合并高血压或糖尿病的慢性肝病患者比例显著高于未合并代谢性疾病的患者(合并高血压:32.3%对17.9%,P < 0.001;合并糖尿病:36.5%对18.1%,P < 0.001)。此外,合并两种代谢性疾病的高风险人群比例显著高于合并一种代谢性疾病和无代谢性疾病的人群(40.9%对31.8%对17.7%,P < 0.001)。aMAP评分可作为基层医院HCC筛查和慢性肝病管理 的一种简单工具,有助于完善慢性肝病患者的个性化随访管理体系。合并代谢性疾病的慢性肝病患者HCC风险更高,对HCC高风险人群应在随访中给予特别优先关注,以提高HCC早期诊断率,降低死亡率。

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