核苷(酸)类似物抗病毒治疗中乙型肝炎肝硬化进展为原发性肝细胞癌危险因素分析  

Risk factors of progression to hepatocellular carcinoma in patients with hepatitis B cirrhosis under nucleoside/nucleotide analogue therapy

作　　者：王维萍 杨丹红[2] 张强[3] 黄益澄[2] 张家杰[2] 潘红英[2] 何亚盛 Wang Weiping;Yang Danhong;Zhang Qiang;Huang Yicheng;Zhang Jiajie;Pan Hongying;He Yasheng(Graduate School of Bengbu Medical College,Bengbu 233000,Anhui Province,China;Department of Infectious Diseases,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Department of Infectious Diseases.Yijishan Hospital of Wannan Medical College,Wuhu 241003,Anhui Province,China)

机构地区：[1]安徽省蚌埠医学院研究生院,233000 [2]浙江省人民医院感染科,杭州310014 [3]安徽省皖南医学院弋矶山医院感染性疾病科,芜湖241003

出　　处：《中华临床感染病杂志》2020年第5期348-352,370,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：浙江省自然科学基金(LY18H190002)。

摘　　要：目的分析核苷(酸)类似物[Nucleoside (acid) analogues,NAs]抗病毒治疗中乙型肝炎肝硬化(乙肝肝硬化)进展为原发性肝细胞癌(Hepatocellular carcinoma,HCC)的危险因素。方法回顾性分析浙江省人民医院2014年11月至2019年10月接受NAs抗病毒治疗的253例乙肝肝硬化及进展为HCC患者的临床资料,并分为肝硬化组137例和HCC组116例。采用多因素Logistic回归分析NAs抗病毒治疗中乙肝肝硬化进展为HCC的危险因素。结果多因素Logistic回归分析显示,年龄(OR=1.094,95%CI 1.034~1.158,P<0.01)、吸烟史(OR=5.056,95%CI 1.453~17.594,P<0.05)、乙肝肝癌家族史(OR=6.763,95%CI 1.253~36.499,P<0.05)、拉米夫定耐药史(OR=6.097,95%CI 1.370~27.134,P<0.05)、空腹血糖水平(Fasting blood glucose,FBG)(OR=7.219,95%CI 3.716~14.024,P<0.01)为乙肝肝硬化进展为HCC的独立危险因素;HBV DNA阴转率(OR=0.028,95%CI 0.006~0.137,P<0.01)为乙肝肝硬化进展为HCC的保护因素。结论乙肝肝硬化患者抗病毒治疗应密切监测是否耐药、HBV DNA及FBG水平,同时采取戒烟、选用高耐药基因屏障的NAs抗病毒药物预防HCC的发生。Objective To explore the risk factors of hepatocellular carcinoma(HCC)in patients with hepatitis B cirrhosis receiving nucleoside/nucleotide analogues(NAs)antiviral therapy.Methods The clinical data of 253 patients receiving NAs antiviral therapy in Zhejiang Provincial People’s Hospital from November 2014 to October 2019 were retrospectively analyzed.During treatment,HCC occurred in 116 patients.Multivariate logistic regression was used to analyze the risk factors of progression to HCC in patients with hepatitis B cirrhosis.Results Multivariate logistic regression analysis showed that age(OR=1.094,95%CI 1.034-1.158,P<0.01),smoking history(OR=5.056,95%CI 1.453-17.594,P<0.05),family history of hepatocellular carcinoma(OR=6.763,95%CI 1.253-36.499,P<0.05),Lamivudin(LAM)resistance(OR=6.097,95%CI 1.370-27.134,P<0.05),fasting blood glucose(FBG)level(OR=7.219,95%CI 3.716-14.024,P<0.01)were independent risk factors for the progression of hepatitis B cirrhosis to HCC;while HBV DNA negative conversion(OR=0.028,95%CI 0.006-0.137,P<0.01)was a protective factor.Conclusions For hepatitis B cirrhosis patients receiving antiviral therapy,drug resistance,HBV DNA,FBG levels should be closely monitored,intervention measures such as quitting smoking should be taken and NAs with high drug resistance gene barrier should be selected to prevent the occurrence of HCC.

关 键 词：乙型肝炎 肝硬化 肝细胞癌 核苷(酸)类似物 抗病毒治疗 危险因素 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学] R735.7