瞬时弹性测定评估甲胎蛋白阴性的慢性乙型病毒性肝炎患者发生原发性肝细胞癌风险的价值  

Relationship between liver stiffness and hepatocellular carcinoma presence in chronic heptatitis B patients with negative α-fetoprotein tests

作　　者：徐斌[1] 李锐[1] 郭燕丽[1] 华兴[1] 唐春霖[1] 

机构地区：[1]第三军医大学西南医院超声科,重庆400038

出　　处：《中华医学超声杂志（电子版）》2015年第4期39-43,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨在甲胎蛋白阴性（AFP≤20 ng/ml）的慢性乙型病毒性肝炎患者中瞬时弹性测定所测量的肝脏硬度值与原发性肝细胞癌（HCC）发生风险的关系。方法纳入2012年9月至2014年8月在第三军医大学第一附属医院就诊的81例患原发性HCC的慢性乙型病毒性肝炎患者作为病例组;同时纳入慢性乙型病毒性肝炎患者253例作为对照组,两组患者AFP测定均为阴性。采用瞬时弹性成像检查仪Fibroscan测量所有患者的肝硬度值。二分类Logistic回归分析HCC发生风险的危险因素。计算分层特异性似然比（SSLR）。结果病例组患者的年龄、肝硬度值、血浆白蛋白中位数（25%,75%）分别为53岁（44,61）、12.00 k Pa（7.50,20.75）、43.14 g/L（39.50,46.75）;对照组患者的年龄、肝脏硬度值、血浆白蛋白中位数（25%,75%）分别为45岁（38,56）、8.40 k Pa（5.40,13.50）、46.40 g/L（43.75,48.50）;两组差异具有统计学意义（t=4.33、3.56、-4.48,P=0.00、0.00、0.00）。二分类Logistic回归分析表明年龄、性别、lg（肝硬度值）分别为肝癌发生的独立性预测因素（OR=1.053、2.432、6.803）。肝硬度值〈10 k Pa,10.1-15 k Pa,15.1-25 k Pa,〉25 k Pa时,HCC发生的SSLR值分别为0.67、1.02、1.44、3.98。结论瞬时弹性成像测量的肝硬度值可在AFP阴性的慢性乙型病毒性肝炎患者中提示HCC发生的风险,临床医师可据此对患者进行重点随访和临床干预。Objective To investigate the relationship between liver stiffness and hepatocellular carcinoma（HCC） risk in chronic heptatitis B patients with negative α-fetoprotein（AFP） tests. Methods From September 2012 to August 2014, this study enrolled a total of 82 HBV-relative native HCC patients as the case group. During the same period, a total of 253 chronic hepatitis B patients were also include in this study as the control group. These 253 patients were followed up for six months. All of the two groups were AFP-negative. Liver stiffness was measured in all patients by transient elastography device Fibroscan？. Logistic regression was applied to assess the risk of HCC incidence, and stratumspecific likelihood ratios（SSLR） was calculated. Results The age, liver stiffness measurements and plasma albumin of patients in case group were 53 years old（44-61）, 12.00 k Pa（7.50-20.75）, 43.14 g/L（39.50-46.75） respectively. The age, liver stiffness measurements and plasma albumin of patients in control group were 45 years old（38-56）, 8.40 k Pa（5.40-13.50）, 46.40 g/L（43.75-48.50） respectively. The variables were compared between two groups with unpaired student t test, and the results were statistically significant（t=4.33, 3.56,-4.48, P=0.00, 0.00, 0.00）. The patients in case group were older, and had higher liver stiffness measurements and lower plasma albumin than that of the patients in control group. Logistic regression analysis showed that HCC incidence was associated with age,male-gender and liver stiffness, and the odds ratios（OR） was 1.053, 2.432, 6.803 respectively. When liver stiffness was 10 k Pa, 10.1-15 k Pa, 15.1-25 k Pa, 25 k Pa, SSLR for HCC presence was 0.67, 1.02,1.44, 3.98 respectively. Conclusions Liver stiffness measured by transient elastography is useful in predicting the risk of HCC incidence in AFP-negative chronic heptatitis B patients. Clinicians needed to carry out close follow-up and appropriate intervention for these patients.

关 键 词：弹性成像技术 肝炎 病毒性 人 癌 肝细胞 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学]