慢性乙型肝炎合并肝细胞癌的临床表现及相关因素比较
Comparison of Clinical Manifestations and Related Factors of Hepatocellular Carcinoma with Chronic Hepatitis B.
作者信息
Hou Haisong, Liang Liu, Deng Lihong, Ye Wanping, Wen Yuanzhang, Liu Jun
机构信息
Laboratory of Pathogenic Biology, Guangdong Medical University, Zhanjiang, People's Republic of China.
Department of Blood Transfusion, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, Meizhou, People's Republic of China.
出版信息
Int J Gen Med. 2024 Jun 25;17:2877-2886. doi: 10.2147/IJGM.S464083. eCollection 2024.
BACKGROUND
The aim of this study was to describe the demographic and clinical characteristics of hepatitis B virus (HBV) associated hepatocellular carcinoma (HCC), analyse the risk factors associated with HBV-associated HCC, and to provide some references to the diagnosis and treatment of HCC.
METHODS
This study retrospectively enrolled 730 patients, including 390 patients with chronic hepatitis B (CHB) as controls, and 340 patients with CHB complicated with HCC as patients. Relevant information and medical records of these participants were collected, including age, sex, cigarette smoking, alcoholism, diabetes mellitus (DM), hypertension, coronary heart disease (CHD), cirrhosis, occupation, ascites, HBV-DNA load, the qualitative analysis of HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb serological markers, and levels of alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), gamma-glutamyltransferase (GGT), TNM stage, tumor size and tumor number. The test, Chi-square test, non-parametric rank-sum test, logistic regression analyses were used to explore the influencing factors and their degree of association with HCC in patients with HBV.
RESULTS
The proportion of smoking, alcoholism, married status, DM, hypertension, and the rate of HBV-DNA with a viral load of ≥500 copies/mL were significantly higher in the HCC group than in the controls (all <0.05). Cirrhosis was more common among patients with CHB+HCC than in controls (=0.013). The proportion of patients with HBsAg, HBeAb, and HBcAb positive was greater in CHB+HCC group than that in CHB group. Logistic regression analysis indicated that age ≥60 years (OR: 1.835, 95% CI: 1.020-3.302, =0.043), HBeAb positive (OR: 9.105, 95% CI: 4.796-17.288, <0.001), antiviral treatment with entecavir (OR: 2.209, 95% CI: 1.106-4.409, =0.025), and GGT (OR: 1.004, 95% CI: 1.001-1.007, =0.002) were risk factors for HCC in patients with CHB.
CONCLUSION
Advanced age, HBeAb positive, antiviral treatment with entecavir, and GGT were independent risk factors for HCC in HBV patients.
背景
本研究旨在描述乙型肝炎病毒（HBV）相关肝细胞癌（HCC）的人口统计学和临床特征，分析与HBV相关HCC相关的危险因素，并为HCC的诊断和治疗提供一些参考。
方法
本研究回顾性纳入730例患者，其中390例慢性乙型肝炎（CHB）患者作为对照，340例CHB合并HCC患者作为病例组。收集这些参与者的相关信息和病历，包括年龄、性别、吸烟、酗酒、糖尿病（DM）、高血压、冠心病（CHD）、肝硬化、职业、腹水、HBV-DNA载量、HBsAg、HBsAb、HBeAg、HBeAb和HBcAb血清学标志物的定性分析，以及丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBIL）、直接胆红素（DBIL）、γ-谷氨酰转移酶（GGT）、TNM分期、肿瘤大小和肿瘤数量。采用t检验、卡方检验、非参数秩和检验、逻辑回归分析探讨HBV患者中HCC的影响因素及其关联程度。
结果
HCC组吸烟、酗酒、婚姻状况、DM、高血压的比例以及病毒载量≥500拷贝/mL的HBV-DNA率均显著高于对照组（均P<0.05）。CHB+HCC患者中肝硬化比对照组更常见（P=0.013）。CHB+HCC组中HBsAg、HBeAb和HBcAb阳性患者的比例高于CHB组。逻辑回归分析表明，年龄≥60岁（OR：1.835，95%CI：1.020-3.302，P=0.043）、HBeAb阳性（OR：9.105，95%CI：4.796-17.288，P<0.001）、恩替卡韦抗病毒治疗（OR：2.209，95%CI：1.106-4.409，P=0.025）和GGT（OR：1.004，95%CI：1.001-1.007，P=0.002）是CHB患者发生HCC的危险因素。
结论
高龄、HBeAb阳性、恩替卡韦抗病毒治疗和GGT是HBV患者发生HCC的独立危险因素。
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