单核细胞/高密度脂蛋白胆固醇比值对原发性非病毒性肝细胞癌患者预后的影响:一项回顾性队列研究  

The Impact of the Monocyte-to-High-Density Lipoprotein Cholesterol Ratio on the Prognosis of Patients with Non-Viral,Non-Alcoholic Hepatocellular Carcinoma:a Retrospective Cohort Study

作　　者：娄贤哲 苗同国 张仕雅 马冬[3] 南月敏[2] LOU Xianzhe;MIAO Tongguo;ZHANG Shiya;MA Dong;NAN Yuemin(School of Public Health,North China University of Science and Technology,Tangshan 063210,China;Department of Hepatology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Hebei Medical University,Shijiazhuang 050017,China)

机构地区：[1]华北理工大学公共卫生学院,河北省唐山市063210 [2]河北医科大学第三医院中西医结合肝病科,河北省石家庄市050051 [3]河北医科大学,河北省石家庄市050017

出　　处：《中国全科医学》2025年第9期1092-1099,共8页Chinese General Practice

基　　金：河北省重点研发计划项目(19277779D)。

摘　　要：背景原发性非病毒性肝细胞癌(NBNC-HCC)的发病率持续增加,脂质代谢异常伴随炎症是NBNCHCC发生的主要原因之一,炎性指标的检测和评估可能是预测NBNC-HCC预后的重要方法。目的 本研究探讨单核细胞/高密度脂蛋白比值(MHR)预测NBNC-HCC患者的预后价值。方法 收集2013年1月—2020年2月在河北医科大学第三医院被诊断为NBNC-HCC的患者119例,收集患者的基线资料和实验室检查结果。将患者依据MHR值四分位数分为Q1(MHR<0.33,n=28)、Q2(0.33≤MHR<0.66,n=31)、Q3(0.66≤MHR<1.59,n=30)、Q4(MHR≥1.59,n=30)组。对患者进行定期随访,记录患者的生存状态、死亡时间等资料,主要观察终点为NBNC-HCC患者的总生存期(OS)。绘制限制性立方样图(RCS)评估入院时MHR与患者死亡的相关性。绘制受试者工作特征曲线(ROC曲线)分析入院时MHR对NBNC-HCC患者36个月预后的预测价值。采用Cox比例风险模型和BP神经网络模型分析NBNC-HCC患者的独立危险因素。采用Kaplan-Meier法绘制NBNC-HCC患者预后的生存曲线并进行Log-rank检验。结果 Q1~Q4组患者糖尿病、接受手术比例、巴塞罗那分期(BCLC分期)、天冬氨酸氨基转氨酶(AST)、C反应蛋白(CRP)、谷氨酰转肽酶(γ-GT)、胆碱酯酶(CHE)、尿素(UREA)、肌酐(Scr)、高密度脂蛋白胆固醇(HDL-C)、白细胞计数(WBC)、红细胞计数(RBC)、单核细胞计数(MONO)、中性粒细胞计数(NEUT)、白蛋白-胆红素评分(ALBI评分)比较,差异有统计学意义(P<0.05)。绘制MHR、MONO、HDL-C预测NBNC-HCC患者预后的ROC曲线,结果显示MHR(AUC=0.822,95%CI=0.742~0.903,P<0.05)对患者预后的预测作用优于MONO(AUC=0.723,95%CI=0.618~0.828)(Z=4.34,P<0.05)和HDL-C(AUC=0.216,95%CI=0.119~0.313)(Z=2.088,P<0.05)。多因素Cox回归分析结果显示BCLC分期B~D期、CRP和MHR是NBNC-HCC患者全因死亡的独立危险因素(P<0.05)。调整高血压、吸烟、饮酒、糖尿病、ALT、AST后,Q2(OR=1.926,95%CI=1.005~3.689,P=0.015)�Background The incidence of primary non-viral hepatocellular carcinoma(NBNC-HCC)continues to increase,and abnormal lipid metabolism accompanied by inflammation is one of the main causes of NBNC-HCC,so the detection and evaluation of inflammatory markers may be an important method to predict the prognosis of NBNC-HCC.Objective To investigate the prognostic value of monocyte/high-density lipoprotein ratio(MHR)as a predictor in patients with NBNC-HCC.Methods A total of 119 patients diagnosed with NBNC-HCC at the Third Hospital of Hebei Medical University between January 2013 and February 2020 were enrolled.General information and laboratory test results were collected.Patients were divided into four groups based on the quartiles of their MHR values:Q1(MHR<0.33,n=28),Q2(0.33≤MHR<0.66,n=31),Q3(0.66≤MHR<1.59,n=30),and Q4(MHR≥1.59,n=30).Patients were followed up regularly,and data on their survival status and time of death were recorded.The primary endpoint was the overall survival(OS)of patients with NBNC-HCC.Restricted cubic splines(RCS)were plotted to assess the correlation between MHR at admission and patient mortality.Receiver operating characteristic(ROC)curves were plotted to analyze the value of MHR at admission in predicting 36-month survival of patients with NBNC-HCC.Cox proportional hazards models and BP neural network models were used to analyze the independent risk factors for patients with NBNC-HCC.The Kaplan-Meier method was used to plot survival curves for the prognosis of patients with NBNC-HCC,and the Log-rank test was performed.Results There were statistically significant differences in diabetes,proportion of surgeries,Barcelona Clinic Liver Cancer(BCLC)stage,aspartate aminotransferase(AST),C-reactive protein(CRP),gamma-glutamyltransferase(γ-GT),cholinesterase(CHE),urea(UREA),creatinine(Scr),high-density lipoprotein cholesterol(HDL-C),white blood cell count(WBC),red blood cell count(RBC),monocyte count(MONO),neutrophil count(NEUT),and albumin-bilirubin(ALBI)score among the Q1 to Q4 groups(P<0.0

关 键 词：癌 肝细胞 原发性非病毒性肝细胞癌 单核细胞/高密度脂蛋白胆固醇比值 队列研究 

分 类 号：R730.261[医药卫生—肿瘤]