原发性肝癌发生感染性并发症的危险因素分析  

Risk factors for infectious complications in primary liver cancer

作　　者：刘洪金 鲍春梅 白文林 李因茵[1] 荣光华 陆荫英 陈艳 刘泽 程家敏 曾珍 LIU Hongjin;BAO Chunmei;BAI Wenlin(Liver Tumor Research and Treatment Center,302 Hospital of PIA,Beijing 100039,China)

机构地区：[1]中国人民解放军第三〇二医院肝脏肿瘤研究与诊疗中心,北京100039 [2]中国人民解放军第三〇二医院临床医学检验中心,北京100039

出　　处：《临床肝胆病杂志》2018年第5期1033-1037,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金资助项目(813722481012487);军队十二五项目(CWS12J024)

摘　　要：目的探究原发性肝癌发生感染性并发症的相关危险因素。方法收集2016年2月-2017年2月解放军第三〇二医院肝脏肿瘤研究与诊疗中心收治的3034例原发性肝癌患者的临床资料,其中发生感染性并发症297例,未发生感染性并发症2737例,分别随机抽取153例感染患者、46例非感染患者为感染组、非感染组。感染组中男133例,女20例,年龄34~75岁,平均(56.41±6.69)岁;非感染组男37例,女9例,年龄47~74岁,平均(57.52±11.12)岁。分析可疑危险因素与原发性肝癌发生感染性并发症的关系。计量资料符合正态性分布的数据2组间比较采用t检验,偏态分布的数据2组间比较采用Wilcoxon秩和检验;计数资料2组间比较采用χ2检验,危险因素分析采用多因素logistic回归分析。结果多因素分析结果显示,患者年龄≤60岁(OR=5.048,P<0.001)、乙型肝炎病程长(OR=2.446,P=0.035)、HBV DNA阳性(OR=2.618,P=0.005)、Child-Pugh评分高(OR=0.167、P=0.004)、Alb水平低(OR=0.834,P<0.001)、胆碱酯酶水平低(OR=0.999,P<0.001)、PT长(OR=1.299,P=0.007)、肝癌病程长(OR=0.433,P=0.016)、肿瘤最大直径大(OR=0.389,P=0.005)、AFP水平高(OR=0.470,P=0.032)、合并门静脉癌栓(OR=2.378,P=0.018)、WBC水平高(OR=1.170,P=0.001)、ALP水平高(OR=1.004,P=0.004)、GGT水平高(OR=1.004,P=0.006)是原发性肝癌患者发生感染性并发症的独立危险因素。结论原发性肝癌患者并发感染与患者发病年龄、乙型肝炎及肝癌病程、肿瘤直径、门静脉癌栓、HBV DNA及AFP水平、肝功能等危险因素有关,临床上应对此给予足够重视并采取积极措施,减少感染性并发症的发生。Objective To investigate the risk factors for infectious complications in patients with primary liver cancer.Methods A retrospective analysis was performed for the clinical data of 3034 patients with primary liver cancer who were admitted to 302 Hospital of PLA from February 2016 to February 2017,and among these patients,297 experienced infectious complications and 2737 did not experience infectious complications;153 patients with infectious complications were enrolled as infection group,and 46 without infectious complications were enrolled as non-infection group.There were 133 male and 20 female patients aged 34-75 years （mean 56.41 ± 6.69 years） in the infection group,and 37 male and 9 female patients aged 47-74 years （mean 57.52 ± 11.12 years） in the non-infection group.The association between possible risk factors and infectious complications in patients with primary liver cancer was analyzed.The t test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank sum test was used for comparison of continuous data with skewed distribution between two groups.The chi-square test was used for univariate analysis,and the multivariate logistic regression analysis was used for multivariate analysis.Results The multivariate logistic regression analysis showed that age ≤ 60 years （OR =5.048,P ＜0.001）,long course of hepatitis B and liver cancer（OR =2.446,P =0.035,OR =0.433,P =0.016）,high HBV DNA （OR =2.618,P =0.005）,high white blood cell count （OR =1.170,P =0.001）,high levels of alpha-fetoprotein （AFP） （OR =0.470,P =0.032）,alkaline phosphatase （OR =1.004,P =0.004）,and gamma-glutamyl transpeptidase （OR =1.004,P =0.006）,high Child-Pugh score （OR =0.167,P =0.004）,low albumin （OR =0.999,P ＜ 0.001） and cholinesterase （OR =0.834,P ＜ 0.001）,long prothrombin time （OR =1.299,P =0.007）,large maximum tumor diameter（OR =0.389,P ＜ 0.005）,and presence of portal vein tumor thrombus （OR =2.378,P =0.018） were indepen

关 键 词：肝肿瘤 感染 危险因素 LOGISTIC模型 

分 类 号：R735.7[医药卫生—肿瘤]