[乙型肝炎相关肝硬化合并高血压患者肝细胞癌的风险评估：一项基于倾向评分匹配的回顾性队列研究]
[Risk assessment of hepatocellular carcinoma in patients with hepatitis B-related cirrhosis and hypertension: a propensity score matching-based retrospective cohort study].
作者信息
Hu J, DU F, Ding L, Wang L, Zhao W
机构信息
Department of Infectious Disease, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang 453003, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2024 Nov 20;44(11):2243-2249. doi: 10.12122/j.issn.1673-4254.2024.11.22.
OBJECTIVE
To analyze the factors affecting the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B-associated cirrhosis (CHB-Cir) complicated by essential hypertension (EH) and explore the impact of EH on HCC risk in patients with CHB-Cir.
METHODS
This study was conducted among the patients with CHB-Cir with or without EH received antiviral therapy in the Infectious Disease Department, Third Affiliated Hospital of Xinxiang Medical University from January, 2017 to January, 2024. The cases with insufficient follow-up time or missing data were excluded. The patients were subjected to propensity score matching in a 1:1 ratio to form an EH group and a non-EH group. The Kaplan-Meier method was used to compare the cumulative incidence of HCC between the two groups, and the Cox proportional hazards regression model was used to analyze the risk of HCC and the factors affecting HCC risk.
RESULTS
A total of 390 CHB-Cir patients (274 male and 116 female patients) were enrolled in this study, including 195 with EH and 195 without EH. In these patients, EH was significantly correlated with the occurrence of HCC (=1.69, =0.002). Multivariate analysis suggested that the male gender (=1.73, =0.005), a family history of liver cancer (=2.23, < 0.001), elevated alpha-fetoprotein (=2.83, =0.001), elevated glutathione reductase (=1.53, =0.046), reduced high-density lipoprotein (=1.46, =0.027), and elevated low-density lipoprotein (=2.29, =0.003) were all significantly correlated with HCC occurrence, while elevated triglycerides (= 0.37, < 0.001) was a protective factor against HCC. In the EH group, treatment with non-RASIs drugs (=2.77, =0.021) and no treatment/diuretic treatment (=7.18, < 0.001) were significantly correlated with HCC occurrence.
CONCLUSION
Hypertension increases the risk of HCC in patients with CHB-Cir, suggesting the importance of controlling hypertension in these patients.
目的
分析慢性乙型肝炎相关肝硬化（CHB-Cir）合并原发性高血压（EH）患者发生肝细胞癌（HCC）风险的影响因素，并探讨EH对CHB-Cir患者HCC风险的影响。
方法
本研究纳入2017年1月至2024年1月在新乡医学院第三附属医院感染科接受抗病毒治疗的CHB-Cir合并或不合并EH的患者。排除随访时间不足或数据缺失的病例。患者按1:1比例进行倾向得分匹配，形成EH组和非EH组。采用Kaplan-Meier法比较两组HCC的累积发病率，采用Cox比例风险回归模型分析HCC风险及影响HCC风险的因素。
结果
本研究共纳入390例CHB-Cir患者（男性274例，女性116例），其中合并EH者195例，未合并EH者195例。在这些患者中，EH与HCC的发生显著相关（=1.69，=0.002）。多因素分析提示，男性（=1.73，=0.005）、肝癌家族史（=2.23，<0.001）、甲胎蛋白升高（=2.83，=0.001）、谷胱甘肽还原酶升高（=1.53，=0.046）、高密度脂蛋白降低（=1.46，=0.027）以及低密度脂蛋白升高（=2.29，=0.003）均与HCC的发生显著相关，而甘油三酯升高（=0.37，<0.001）是HCC的保护因素。在EH组中，使用非肾素-血管紧张素系统抑制剂（RASIs）药物治疗（=2.77，=0.021）以及未治疗/使用利尿剂治疗（=7.18，<0.001）与HCC的发生显著相关。
结论
高血压增加CHB-Cir患者发生HCC的风险，提示控制这些患者的高血压具有重要意义。
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