不同治疗方案的慢性乙型病毒性肝炎患者肝癌累积发生率及危险因素COX回归分析  

Cox regression analysis on the cumulative incidence and the risk factors of hepatocellular carcinoma in the patients of chronic viral hepatitis treated with different regimens

作　　者：姜小艳 魏春山[2] 童光东[2] 彭立生[2] 彭德倜 黄彬[2] JIANG Xiao -yan;WEI Chun -shan;TONG Guang -dong;PENG Li - sheng;PENG De - ti;HUANG Bin(The Fourth Clinical Medical School of Guangzhou University of Traditional Chinese Medicine, Shenzhen Guangdong 518033;Shenzhen Chinese Medicine Hospital, Shenzhen Guangdong 518033)

机构地区：[1]广州中医药大学第四临床医学院 [2]深圳市中医院,广东深圳518033

出　　处：《世界中西医结合杂志》2018年第4期449-453,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：深圳市科技计划项目(JCYJ20150401163247220)

摘　　要：目的探究不同治疗状态下慢性乙型病毒性肝炎(CHB)患者肝癌(HCC)的累积发生率及危险因素COX回归分析。方法采用回顾性研究方法,通过对长期治疗并随访,且接受不同治疗方案的CHB患者进行回顾性统计,对不同治疗方案(抗炎保肝组、抗病毒组、先抗炎保肝后抗病毒组)的患者HCC累积发生率分析,并对HCC发生的年龄、性别、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TB)等因素进行COX风险回归模型分析。结果三组患者中,抗病毒组患者HCC累积发生率最高,抗炎保肝组患者HCC累积发生率最低。危险因素COX回归模型分析显示肝硬化是所有患者HCC发生的独立危险因素。抗炎保肝组中,女性是HCC发生的保护因素。抗病毒组患者年龄>40岁、4.30~6.30 Log(2×104~2×106IU/L)的DNA水平、ALT>50U/L是HCC发生的危险因素。先抗炎保肝后抗病毒组患者,2.70~6.30 Log(2×102~2×106IU/L)的DNA水平是HCC发生的独立危险因素。结论即使患者接受了抗病毒治疗,仍需严密监测患者HCC的发生,CHB的抗炎保肝治疗是必要的,及时抗病毒治疗,防止患者发生肝硬化,是减少HCC发生的重要举措。Objective To explore the Cox regression analysis on the cumulative incidence and the risk factors of hepatocellular carcinoma(HCC） in the patients of chronic viral hepatitis B(CHB） treated with different regimens. Methods Using the retrospective study,through the long-term treatment and follow-up visit,the retrospective statistical analysis was conducted in CHB patients treated with different regimens. The cumulative incidence of HCC treated with different regimens(the treatment for anti-inflammation and liver protection,the treatment for anti-virus,the treatment for anti-virus after anti-inflammation and liver protection） was analyzed. With the Cox risk regression model,the factors of HCC were analyzed,such as the age,gender,ALT,AST and TB. Results Among the patients with three different treatment regimens,HCC cumulative incidence was the highest in the treatment for anti-virus and that was the lowest in the treatment for anti-inflammation and liver protection. With the Cox regression model analysis,it was shown that the risk factors of HCC were the independent risk factors of HCC for all the patients. In the treatment for anti-inflammation and liver protection,the female was the protection factor of HCC. In the treatment for anti-virus,the age( 40 years）,DNA(4. 30-6. 30 Log(2 ×104-2 × 10^6 IU/L） and ALT(〉 50 U/L） were the risk factors of HCC. In the treatment for anti-virus after anti-inflammation and liver protection,DNA(2. 70-6. 30 Log(2 × 10^2-2 × 10^6 IU/L）） was the independent risk factor of HCC.Conclusion It is still necessary to rigorously monitor the incidence of HCC even though the anti-viral therapy is adopted in the patients. It is necessary to provide the treatment for anti-inflammation and liver protection for CHB. The in-time anti-viral treatment and the prevention from liver cirrhosis are the important measures for reducing the occurrence of HCC.

关 键 词：慢性乙型病毒性肝炎 肝癌 发生率 危险因素 

分 类 号：R512.61[医药卫生—内科学] R735.7[医药卫生—临床医学]