经抗病毒治疗的慢性乙型病毒性肝炎患者随访间隔时间对肝细胞癌早期诊断的影响  

Effect of follow-up intervals on early diagnosis of hepatocellular carcinoma in patients with chronic viral hepatitis B treated with antiviral therapy

作　　者：陈秋月 何泽宝[3] 余真君 方哲平[4] 张道春[5] 莫经刚 赵海红[3] 谈朦 阮冰[6] Chen Qiuyue;He Zebao;Yu Zhenjun;Fang Zheping;Zhang Daochun;Mo Jingang;Zhao Haihong;Tan Meng;Ruan Bing(Taizhou Central Hospital(Affiliated Hospital of Taizhou College),Taizhou 318000,China;不详)

机构地区：[1]台州市中心医院台州学院附属医院内科,浙江台州318000 [2]台州市中心医院台州学院附属医院肝胆外科,浙江台州318000 [3]浙江省台州医院台州恩泽医疗中心(集团)恩泽医院公共卫生中心 [4]浙江省台州医院台州恩泽医疗中心(集团)恩泽医院肝胆外科 [5]浙江省台州医院台州恩泽医疗中心(集团)恩泽医院放射科 [6]浙江大学医学院附属第一医院传染病诊治国家重点实验室,国家感染性疾病临床医学研究中心

出　　处：《临床内科杂志》2020年第8期561-564,共4页Journal of Clinical Internal Medicine

基　　金：十三五重大科技专项课题(2017ZX10105001-001);国家人类遗传资源共享服务平台项目(2005DKA21300);浙江省自然科学基金项目(LY16H030001);台州市科技计划项目(2015A33259、2015A33088)。

摘　　要：目的分析经抗病毒治疗的慢性乙型病毒性肝炎(CHB)患者肝细胞癌(HCC)发生情况,探讨不同随访间隔时间对HCC早期诊断的影响。方法纳入接受随访的抗病毒治疗的病例资料相对完整的CHB和乙型肝炎肝硬化患者2892例。按随访期间是否发生HCC将其分为HCC组(64例)和非HCC组(2828例);按随访间隔时间及乙型肝炎病毒(HBV)DNA水平差异将其分为5组:A组:每3~6个月检查1次,中位检查时间4.1个月,HBV DNA<5×10^2 IU/ml;B组:每3~6个月检查1次,中位检查时间4.5个月,5×10^2 IU/ml≤HBV DNA≤1×10^4 IU/ml,未及时调整用药;C组:每6~12个月检查1次,中位检查时间7.3个月,HBV DNA<5×10^2 IU/ml;D组:每6~12个月检查1次,中位检查时间7.2个月,5×10^2 IU/ml≤HBV DNA≤1×10^4 IU/ml,未及时调整用药;E组:不规律检查,中位检查时间1.5年,HBV DNA>1×10^4 IU/ml,未及时调整用药。其中A、B、C、D组均规范抗病毒治疗,E组未规范抗病毒治疗。收集所有患者的一般资料及临床资料,包括年龄、性别、吸烟及饮酒情况、随访期间是否发生HCC、HCC临床分期情况并比较。结果与非HCC组比较,HCC组患者年龄较大、吸烟及饮酒患者比例较高(P<0.01)。随访间隔时间一致、HBV DNA水平不同条件下,A组患者HCC发生率低于B组,C组患者HCC发生率低于D组(P<0.05)。HBV DNA水平一致、随访间隔时间不同条件下,A组患者HCCⅠa期发生率高于C组,B组患者HCCⅠa期发生率高于D组(P<0.05)。E组患者HCC发生率均明显高于其余4组(P<0.01)。低HBV DNA水平组患者HCC发生率低于高HBV DNA水平组(P<0.01)。结论对于HCC高危人群,随访间隔时间长短与HCC发生率无关,但缩短随访时间有助于HCC的早期诊断。Objective Analyze the occurrence of hepatocellular carcinoma(HCC)in patients with chronic hepatitis B(CHB)treated with antiviral therapy,explore the influence of different follow-up intervals on the early diagnosis of HCC.Methods A total of 2892 patients with CHB and Hepatitis B cirrhosis treated with relatively complete case data were included and followed up with antiviral therapy,and divided into the HCC group(64 cases)and non-HCC group(2828 cases)according to whether HCC had occurred during follow-up.All patients were divided into 5 groups according to the follow-up interval and the difference of Hepatitis B virus(HBV)DNA level:Group A:Examination once every 3 to 6 months,median inspection time was 4.1 months,HBV DNA<5×10^2 IU/ml;Group B:Examination once every 3 to 6 months,median inspection time was 4.5 months,5×10^2 IU/ml≤HBV DNA≤1×10^4 IU/ml,without adjustment of medication timely;Group C:Examination once every 6 to 12 months,median inspection time was 7.3 months,HBV DNA<5×10^2 IU/ml;Group D:Examination once every 6 to 12 months,median inspection time was 7.2 months,5×10^2 IU/ml≤HBV DNA≤1×10^4 IU/ml,without adjustment of medication timely;Group E:Irregular examination,median inspection time was 1.5 months,HBV DNA>1×10^4 IU/ml,without adjustment of medication timely.Normative antiviral therapyt was standardized in the A,B,C,D groups,while non-normative antiviral therapy was standardized in the E group.General and clinical data were collected for all patients,including age,sex,smoking and alcohol consumption,whether HCC had occurred during the follow-up period and the clinical stages of HCC were compared.Results Compared with the non-HCC group,patients in the HCC group were older and had a higher proportion of smokers and drinkers(P<0.01).Under the same follow-up interval and different HBV DNA levels,the HCC incidence in group A was lower than that in group B and that in group C was lower than that in group D(P<0.05).Under the conditions of consistent HBV DNA levels and different follow-up int

关 键 词：慢性乙型病毒性肝炎 肝硬化 肝细胞癌 随访模式 早期诊断 

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