乙型肝炎相关原发性肝癌患者的生存分析  

Survival analysis on patients with hepatitis B related primary liver cancer

作　　者：姚珊珊[1] 刘慧敏[2] 刘艳民[1] 谷莉莉[2] 王宪波[1] 

机构地区：[1]首都医科大学附属北京地坛医院,北京100015 [2]北京中医药大学

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第1期55-60,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市科技计划课题(No.Z111107056811044);北京市中医药科技发展基金科技提升专项(No.KJTS2011-05);首都医学发展基金(No.SF-2007-Ⅲ-03)

摘　　要：目的探讨影响乙型肝炎相关原发性肝癌患者1年预后的独立指标并建立危险指数模型,评价该模型对于判断此类患者1年内死亡风险的价值。方法收集首都医科大学附属北京地坛医院2008年9月～2012年7月所收治的434例乙型肝炎相关原发性肝癌患者的临床资料,随机选出257例(60%)组成建模组,其余177例(40%)组成验证组。观察影响患者1年预后的危险因素,运用Cox风险比例回归模型进行单因素和多因素生存分析。根据多因素分析的结果建立危险指数模型,并评价其判断此类患者1年内死亡风险的价值。结果 Cox回归模型分析结果显示,影响患者1年预后的独立指标共有6个,分别为中性粒细胞/淋巴细胞比值(NLR)、终末期肝病模型(MELD)评分、中性粒细胞计数(NC)、红细胞(RBC)计数、低密度脂蛋白胆固醇(LDL-C)和载脂蛋白A1(ApoA1)。根据以上指标建立的危险指数模型:PI=3+0.062×NLR+0.137×MELD+0.114×NC-0.365×RBC+0.639×(LDL-C)-1.377×(ApoA1),界值为3.58。建模组受试者工作特征(ROC)曲线下面积高达0.857,准确性为78.6%。验证ROC曲线下面积为0.858,准确性为78.5%。结论本研究建立的危险指数模型判断乙型肝炎相关原发性肝癌1年内死亡风险的准确性高,对于临床医生判断患者转归情况,选用更合理的治疗方法具有一定的参考价值。Objective To establish a risk index model by statistical analysis on independent prognostic factors which affect the prognosis of patients with hepatitis B related primary liver cancer in one year, and its value would be evaluated on predicting the mortality risk of these patients. Methods Total of 434 patients with hepatitis B related primary liver cancer in our hospital during September 2008 to July 2012 were enrolled. They were randomly divided into training group （257 cases, 60% ） and validation group （ 177 cases, 40% ）. First, some prognostic risk factors were obtained through clinical observation. Then, the univariate and multivariate survival analysis were performed using Cox regression model. Based on the multivariate analysis results, a risk index model was established and its effects on predicting the one-year mortality risk of those patients were evaluated. Results Cox regression analysis showed that there were six independent factors affecting the prognosis of patients with hepatitis B related primary liver cancer in one year, which were neutrophil-to-lymphoeyte ratio （NLR）, MELD score, neutrophil count （NC） , red blood cell （RBC） count, low density lipoprotein cholesterol （LDL-C） and apolipoprotein A1 （Apo A1 ）, respectively. The risk index model established according to the above factors was expressed as PI = 3 ＋ 0.062 x NLR ＋ 0.137 x MELD ＋ 0.114 x NC-0.365 x RBC ＋ 0.639 x （LDL-C） - 1.377 x （Apo A1） , and the cut-off value was 3.58. In the training group, the area under the receiver operating characteristic curve （AUROC） and the accuracy were 0. 857 and 78. 6% , respectively. While in the validation group, the AUROC and the accuracy were 0. 858 and 78.5% , respectively. Conclusions The risk index model was established in this study to predict the mortality risk of hepatitis B related primary liver cancer, with a high accuracy. It could help doctors to evaluate the patients＇ conditions and choose reasonable treatment methods.

关 键 词：原发性肝癌 肝炎 乙型 生存分析 COX模型 

分 类 号：R735.7[医药卫生—肿瘤]