本文選題：乙型病毒性肝炎　切入點：肝硬化　出處：《山東醫(yī)藥》2017年32期

【摘要】：目的探討接受抗病毒治療的代償期乙肝肝硬化患者進展為肝細胞癌(肝癌)的危險因素。方法收集抗病毒治療至少12個月的代償期乙肝肝硬化患者95例,根據(jù)其是否進展為肝癌分為肝癌組16例和非肝癌組79例。收集并比較兩組臨床資料,包括性別、年齡、肝癌家族史、病毒學(xué)應(yīng)答(抗病毒治療6個月時HBV DNA測不出)情況、核苷(酸)類似物耐藥情況,以及抗病毒治療前HBe Ag定性檢查結(jié)果、血清HBV DNA的log10、血清天門冬氨酸氨基轉(zhuǎn)移酶(AST)、血清白蛋白、血小板計數(shù)。以兩組間比較差異有統(tǒng)計學(xué)意義的資料為自變量,以進展為肝癌為因變量,對自變量分別賦值進行COX回歸模型分析,確定進展為肝癌的危險因素。結(jié)果兩組抗病毒治療前血清AST水平、抗病毒治療前血清白蛋白水平、肝癌家族史、核苷(酸)類似物耐藥構(gòu)成比比較P均0.05,兩組年齡及性別男、抗病毒治療前HBe Ag陽性、病毒學(xué)應(yīng)答構(gòu)成比、抗病毒治療前血清HBV DNA的log10、抗病毒治療前血小板計數(shù)比較P均0.05。上述4項有意義的指標(biāo)納入多因素COX回歸分析結(jié)果顯示,抗病毒治療前血清AST水平的HR為12.05,95%CI為2.65~55.56,P=0.001;抗病毒治療前血清白蛋白水平的HR為1.10,95%CI為0.95~1.27,P=0.201;肝癌家族史的HR為3.51,95%CI為0.80~15.41,P=0.096;核苷(酸)類似物耐藥的HR為5.71,95%CI為1.31~24.83,P=0.020。結(jié)論抗病毒治療前血清AST水平升高和核苷(酸)類似物耐藥是接受抗病毒治療的代償期乙肝肝硬化患者進展為肝癌的危險因素。
[Abstract]:Objective to investigate the risk factors of progression to hepatocellular carcinoma (HCC) in patients with compensatory hepatitis B cirrhosis treated with antiviral therapy. Methods 95 patients with compensatory hepatitis B cirrhosis treated with antiviral therapy for at least 12 months were collected. According to its progression, HCC was divided into HCC group (n = 16) and non-HCC group (n = 79). The clinical data of the two groups were collected and compared, including sex, age, family history of liver cancer, virological response (HBV DNA could not be measured at 6 months after antiviral therapy). The drug resistance of nucleoside (acid) analogue, and the qualitative examination of HBe Ag before antiviral therapy, the log10 of serum HBV DNA, the aspartate aminotransferase of aspartate, the serum albumin, Platelet count. Taking the data with statistical significance as independent variable and progression as dependent variable, the independent variables were assigned by COX regression model. Results Serum AST level, serum albumin level before antiviral therapy, family history of liver cancer, ratio of drug resistance to nucleoside analogues were all 0.05 in the two groups (P < 0.05). Before antiviral therapy, HBe Ag was positive, virological response ratio, log10 of serum HBV DNA and platelet count before antiviral therapy were all P 0.05. The results of multivariate COX regression analysis showed that the above four significant indexes were included in multivariate COX regression analysis. Before antiviral therapy, the HR of serum AST level was 12.05% 95 CI was 2.65% 55.56% P0. 001; before antiviral therapy, the HR of serum albumin level was 1.1095% CI was 0.951.27% P0. 201; the family history of liver cancer was 3.51% 95% CI was 0.8015.41% P0. 096; the HR of nucleoside (acid) analogues was 5.71 95 CI was 1. 31% 24. 83% P0. 020. Conclusion the HR of family history of liver cancer is 0. 8015. 41P0. 096; the HR of nucleoside (acid) analogues is 5. 71% 95% CI is 1. 31% 24. 83% P0. 020.Conclusion the HR of family history of liver cancer is 0. 8015. 41. Elevated serum AST levels and resistance to nucleoside (acid) analogues are risk factors for progression to liver cancer in patients with compensatory hepatitis B cirrhosis treated with antiviral therapy.
【作者單位】： 山東大學(xué)第二醫(yī)院;
【基金】：山東省科技發(fā)展計劃項目(2016031710)
【分類號】：R512.62;R575.2;R735.7
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本文編號：1681083