乙型肝炎相关性肝细胞癌患者预后的多因素分析*

doi:10.3969/j.issn.1672-5069.2018.06.024

摘要/Abstract

摘要： 目的探讨影响乙型肝炎相关性肝细胞癌（HCC）患者预后的因素。方法 2008年1月~2015年11月在上海瑞金医院确诊和治疗的乙型肝炎相关性HCC患者469例,根据血清HBV DNA水平将患者分为高病毒载量组（HBV DNA≥1×10⁴ copies/ml）和低病毒载量组（HBV DNA<1×10⁴copies/ml）,比较两组患者肝功能、甲胎蛋白、应用核苷或核苷酸类（NAs）治疗、巴塞罗那分期对生存时间的影响。结果在入组的469例患者中,低病毒载量组243例（51.8 %）,高病毒载量组226 例（48.2 %）;低病毒载量组平均年龄为54±10岁,高病毒载量组平均年龄为52±10岁,无显著差异（P>0.05）;在低病毒载量组中男性213例（87.7%）,女性30例（12.3%）,而在高病毒载量组中分别为205例（90.7 %）和21例（9.2 %,P>0.05）;低病毒载量组血清谷丙转氨酶（ALT）和谷草转氨酶（AST）水平显著低于高病毒载量组（P<0.05）;低病毒载量组平均生存时间为（1144±732） d,显著长于高病毒载量组[（496±278） d,P<0.05];单因素分析发现影响乙型肝炎相关性HCC患者预后的因素包括是否接受NAs抗病毒治疗（P<0.01）、血清AFP≥40 μg/L（P<0.05）、血清 ALT≥64 IU/L（P<0.01）、血清AST≥40 IU/L（P<0.001）、血清总胆红素≥24 μmol/L（P<0.001）、血清直接胆红素≥6.8 μmol/L （P<0.001）、血清HBV DNA≥1×10⁴ copies/ml （P<0.001）;经多因素分析,发现BCLC 分期为晚期（HR为1.84,CI 为1.57~2.15,P<0.001）、未接受NAs治疗（P<0.01）、血清AST≥40 IU/L（P<0.05）和HBV DNA≥1×10⁴ copies/ml （P<0.001）为影响乙型肝炎相关性HCC预后的独立危险因素。结论 HCC患者的预后受到多种因素的影响,其中血清病毒载量和是否接受NAs抗病毒治疗极其重要。

关键词: 肝细胞癌, 慢性乙型肝炎, HBV DNA载量, 核苷或核苷酸类药物, 预后

Abstract: Objective To investigate the prognosis of patients with hepatocellular carcinoma（HCC） and underlying chronic hepatitis B（CHB）. Methods 469 patients with CHB-related HCC were recruited in our hospital between January 2008 and November 2015,and 243（51.8 %） of them had low serum HBV loads （HBV DNA<1×10⁴ copies/ml） and 226 （48.2%） had high （HBV DNA≥1×10⁴ copies/ml）. The baseline characteristics,nucleoside analogues（NAs） treatment,serum HBV DNA loads and liver function index was recorded. The prognosis of patients in the two groups was analyzed by Logistic analysis. Result The average age in patients with low and in with high serum HBV load were （54±10） yr and （52±10） yr,no significant difference （P>0.05）;the men in patients with low serum HBV DNA were 213 （87.7%）,while the percentage of men was 90.7 %,no significant difference between them （P>0.05）;serum ALT and AST levels in patients with low serum HBV DNA were （80±105） u/L and （55±72） u/L,respectively,much lower than （114±130） u/L and （80±107） u/L in patients with high serum HBV load （P<0.05）;the survival time in patients with low serum HBV load was（1144±732） d,much longer than [（496±278） d,P<0.05] in patients with high serum HBV load;univariate analysis showed that anti-rival therapy,serum AFP level≥40 μg/L,serum ALT level ≥64 IU/L,serum AST level≥40 IU/L,serum bilirubin level≥24 μmol/L and serum HBV DNA load≥1×10⁴ copies/ml were the factors affecting the survival of patients with HCC（P<0.001）;multivariate analysis showed than the BCLC stage（HR=1.84,CI 为1.57-2.15,P<0.001）,without anti-viral therapy （P<0.01）, serum AST≥40 IU/L （P<0.05） and serum HBV DNA ≥1×10⁴ copies/ml （P<0.001） were the independent factors for poor prognosis of patients with hepatitis B-related HCC. Conclusions Many factors impact the survival of patients with CHB-related HCC,and serum HBV loads and anti-viral therapy might be taken into consideration in clinical practice.

Key words: Chronic hepatitis B, HCC, HBV DNA, NAs, prognosis

安宝燕, 王云, 项晓刚, 陈利文, 闫蕾, 曹竹君, 丁叶舟, 汤伟亮, 林兰意, 谢青, 王晖. 乙型肝炎相关性肝细胞癌患者预后的多因素分析^*[J]. 实用肝脏病杂志, 2018, 21(6): 924-927.

Baoyan, Wang Yun, Xiang Xiaogang, et al.. Prognosis of patients with hepatocellular carcinoma and underlying hepatitis B An [J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(6): 924-927.

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乙型肝炎相关性肝细胞癌患者预后的多因素分析^*

Prognosis of patients with hepatocellular carcinoma and underlying hepatitis B An

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