免疫联合靶向治疗肝癌病人发生远期脑卒中风险分析  

Analysis of the risk of long-term stroke in patients with hepatocellular carcinoma treated with immunetargeted combination therapy

作　　者：杨坤 龙云祥 刘彤[1] 吴坤瑾 刘辉 王亚文[2] 刘昌[1] 李国良[3] 曲凯[1,2] YANG Kun;LONG Yun-xiang;LIU Tong(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;School of the Future Technology,Xi’an Jiaotong University,Xi’an 710049,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,陕西西安710061 [2]西安交通大学第一附属医院生物样本信息资源中心,陕西西安710061 [3]西安交通大学第一附属医院心内科,陕西西安710061 [4]西安交通大学未来技术学院,陕西西安710049

出　　处：《中国实用外科杂志》2022年第11期1294-1299,共6页Chinese Journal of Practical Surgery

基　　金：陕西省自然科学基金项目(No.2020JM-373)。

摘　　要：目的探索免疫联合靶向治疗对原发性肝癌病人发生远期脑卒中的影响。方法回顾性分析2016年1月至2018年12月西安交通大学第一附属医院肝胆外科134例原发性肝癌病人临床资料,采用单因素及多因素Cox回归筛选出影响原发性肝癌病人发生远期脑卒中的相关危险因素,采用倾向性评分匹配对独立危险因素和组间差异因素进行匹配,Kaplan-Meier法对相关危险因素的脑卒中发生率进行估计,绘制生存曲线并进行统计学检验。结果多因素Cox回归分析发现年龄、免疫靶向联合治疗是肝癌病人发生远期脑卒的独立危险因素(P<0.05),Kaplan-Meier预后分析显示在匹配前后免疫靶向联合治疗均是肝癌病人发生远期脑卒的重要风险因素,匹配前风险比为9.1、匹配后风险比为11.8(均P<0.05)。结论免疫联合靶向治疗的肝癌病人发生远期脑卒中的风险增加。Objective To analyze the risk of long-term stroke during immunotherapy combined with targeted therapy in patients with primary liver cancer.Methods The clinical data of 134 patients with primary hepatocellular carcinoma in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiao tong University from January 2016 to December 2018 were retrospectively analyzed.Univariate and multivariate Cox regression was used to screen out the related risk factors for long-term stroke in patients with primary liver cancer,and propensity score matching was used to match independent risk factors and factors that differed between groups,Kaplan-Meier method was used to estimate the incidence of stroke among the target risk factors,and survival curves were plotted and statistically tested.Results Multivariate Cox regression analysis showed that age and immunotherapy combined with targeted therapy were independent risk factors for long-term stroke in patients with liver cancer(P<0.05).Kaplan-Meier prognostic analysis showed that immunotherapy combined with targeted therapy was an important risk factor for long-term stroke in patients with primary hepatocellular carcinoma before and after matching;the hazard ratio was 9.1 before matching and 11.8 after matching(all P<0.05).Conclusion Immunotherapy combined with targeted therapy increases the risk of long-term stroke in primary hepatocellular carcinoma patients.

关 键 词：免疫治疗 靶向治疗 肝癌 脑卒中 

分 类 号：R6[医药卫生—外科学]