Yang Da-Long, Liu Shao-Ping, Wang Hong-Liang, Li Jian-Rong, Su Jia-Yong, Li Min-Jun, Teng Yu-Xian, Deng Zhu-Jian, Li Zhong-Hai, Huang Jian-Li, Guo Ping-Ping, Ma Liang, Li Zhen-Zhen, Zhong Jian-Hong
Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning, China.
Hepatobiliary Surgery Department, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, China.
Infect Agent Cancer. 2024 May 1;19(1):21. doi: 10.1186/s13027-024-00575-6.
This study compared the prevalences of metabolic syndrome and of cardiac or kidney comorbidities among patients with hepatocellular carcinoma (HCC) associated with metabolic dysfunction-related fatty liver disease (MAFLD), chronic infection with hepatitis B or C virus (HBV or HCV), or the combination of MAFLD and chronic HBV infection.
Medical records were retrospectively analyzed for patients with HCC who underwent hepatectomy between March 2013 and March 2023. Patients with HCC of different etiologies were compared in terms of their clinicodemographic characteristics and laboratory data before surgery.
Of the 2422 patients, 1,822 (75.2%) were chronically infected with HBV without MAFLD and HCV, 415 (17.2%) had concurrent MAFLD and chronic HBV infection but no HCV infection, 121 (5.0%) had MAFLD without hepatitis virus infection, and 64 (2.6%) were chronically infected with HCV in the presence or absence of MAFLD and HBV infection. Compared to patients chronically infected with HBV without MAFLD and HCV, those with MAFLD but no hepatitis virus infection showed significantly lower prevalence of cirrhosis, ascites, portal hypertension, alpha-fetoprotein concentration ≥ 400 ng/mL, tumor size > 5 cm, multinodular tumors and microvascular invasion. Conversely, they showed significantly higher prevalence of metabolic syndrome, hypertension, type 2 diabetes, abdominal obesity, history of cardiovascular disease, T-wave alterations, hypertriglyceridemia and hyperuricemia, as well as higher risk of arteriosclerotic cardiovascular disease. Compared to patients with MAFLD but no hepatitis virus infection, those with concurrent MAFLD and chronic infection with HBV showed significantly higher prevalence of cirrhosis, ascites and portal hypertension, but significantly lower prevalence of hypertension and history of cardiovascular disease. Compared to patients with other etiologies, those chronically infected with HCV in the presence or absence of MAFLD and HBV infection, showed significantly higher prevalence of cirrhosis, portal hypertension, ascites, and esophagogastric varices.
Patients with HCC associated with MAFLD tend to have a background of less severe liver disease than those with HCC of other etiologies, but they may be more likely to suffer metabolic syndrome or comorbidities affecting the heart or kidneys.
本研究比较了与代谢功能障碍相关脂肪性肝病（MAFLD）、慢性乙型或丙型肝炎病毒（HBV或HCV）感染，或MAFLD与慢性HBV感染合并存在相关的肝细胞癌（HCC）患者中代谢综合征以及心脏或肾脏合并症的患病率。
对2013年3月至2023年3月期间接受肝切除术的HCC患者的病历进行回顾性分析。比较不同病因的HCC患者术前的临床人口统计学特征和实验室数据。
在2422例患者中，1822例（75.2%）为慢性HBV感染且无MAFLD和HCV感染，415例（17.2%）同时患有MAFLD和慢性HBV感染但无HCV感染，121例（5.0%）有MAFLD但无肝炎病毒感染，64例（2.6%）无论是否存在MAFLD和HBV感染均为慢性HCV感染。与慢性HBV感染且无MAFLD和HCV感染的患者相比，有MAFLD但无肝炎病毒感染的患者肝硬化、腹水、门静脉高压、甲胎蛋白浓度≥400 ng/mL、肿瘤大小>5 cm、多结节肿瘤和微血管侵犯的患病率显著较低。相反，他们代谢综合征、高血压、2型糖尿病、腹部肥胖、心血管疾病史、T波改变、高甘油三酯血症和高尿酸血症的患病率显著较高，以及动脉粥样硬化性心血管疾病的风险较高。与有MAFLD但无肝炎病毒感染的患者相比，同时患有MAFLD和慢性HBV感染的患者肝硬化、腹水和门静脉高压的患病率显著较高，但高血压和心血管疾病史的患病率显著较低。与其他病因的患者相比，无论是否存在MAFLD和HBV感染的慢性HCV感染患者肝硬化、门静脉高压腹水和食管胃静脉曲张的患病率显著较高。
与其他病因的HCC患者相比，与MAFLD相关的HCC患者肝病严重程度较低，但他们可能更容易患代谢综合征或影响心脏或肾脏的合并症。
