青年肝炎、肝硬化患者中肝癌早期诊断的相关因素  

The related factors in diagnosing early-phase hepatic cancer in young patients with hepatitis or cirrhosis

作　　者：沈玲[1] 赵伟[1] 舒伟平[1] 方之勋[1] 

机构地区：[1]南京市第二医院,210003

出　　处：《江苏医药》2005年第6期416-418,共3页Jiangsu Medical Journal

摘　　要：目的探讨青年慢性肝炎(CAH)、肝硬化(HLC)患者中肝癌(PHC)早期诊断的相关因素。方法对324例年龄<39岁的青年CAH、HLC、PHC患者进行调查,从家族史、过去史、饮酒史、临床症状、体征、肝功生化指标、AFP、HBVM进行比较分析,并进行相对危险度(OR值)计算。结果(1)PHC组的男女之比4.16∶1;(2)PHC组72.63%的患者合并肝硬化;(3)HLC组,有明确的家族肿瘤史及肝癌史者,发生肝癌的相对危险度(OR)分别为26.78和2.27;(4)PHC组中,16.84%有长期大量饮酒史,OR值为3.78;(5)PHC组AFP(+)率68.36%,>400ng/ml者占44.89%,而CAH及HLC组AFP(+)率则为12.26%、15.00%,仅0、1.67%(>400ng/ml);(6)HBV感染标记随CAH→HLC→PHC的发展呈递减关系。结论男性青年CAH、HLC是PHC的高危人群;肝炎的病程与反复发作及PHC的发生密切相关;家族肝癌及其他肿瘤史在青年肝癌的发生中相对危险度较高,长期大量饮酒对乙肝病毒确有加速和加重作用,为肝癌的一个促发因素;腹泻是肝癌患者常见的、较早出现的一个临床症状,应引起医务人员重视。Objective To discuss the related factors in diagnosing early-phase hepatic cancer in young patients with hepatitis.Methods The retrospective investigation was performed in young patients with hepatitis,hepatic cirrhosis or cancer.The illness and family history,drinking,clinical symptoms and signs,hepatic functions and AFP were analysed.The rate of relative riskfulness(OR) was calculated. Results (1)The ratio of man/women was 4.16/1 in patients with hepatitis,cirrhosis and hepatic cancer respectively.(2)72.63% of young patients with primary hepatic cancer(PHC) was accompanied by cirrhosis.(3)In the patients with cirrhosis,the OR values of PHC were 26.78 and 2.27 in tumor and PHC family respectively.(4)16.84% of the patients with PHC had long-period of drinking,and their OR value was 3.78.(5)The AFP value greater than 400ng/ml was found in 68.36% of all patients with PHC.Whereas,the AFP was 20~200ng/ml in 12.26% of patients with CAH,>400ng/ml in 1.67%.(6)The positive rate of HBV mark was gradually decreased as the disease developed.Conclusion Young patients with hepatitis or cirrhosis are the high risk population of PHC.The most risk facctor of PHC is cirrhosis.The duration of hepatitis is correlated with the rate of PHC.The family history of tumour is an intensive factor of PHC.Drinking for a long period of time spends the physiological features of patients with hepatitis B and promotes the occurrence of PHC.Diarrhoea is one of the early symptoms in the patients with PHC.

关 键 词：早期诊断 肝硬化患者 相关 相对危险度 肝功生化指标 长期大量饮酒 临床症状 家族肿瘤史 大量饮酒史 HBV感染 CAH PHC HLC 慢性肝炎 比较分析 HBVM 男性青年 高危人群 反复发作 加重作用 乙肝病毒 促发因素 肝癌患者 医务人员 

分 类 号：R575.2[医药卫生—消化系统] R181.2[医药卫生—内科学]