接受抗病毒治疗的代偿期乙肝肝硬化患者进展为肝癌的危险因素分析
Shandong Medical Journal（2017）
Abstract
目的 探讨接受抗病毒治疗的代偿期乙肝肝硬化患者进展为肝细胞癌(肝癌)的危险因素.方法 收集抗病毒治疗至少12个月的代偿期乙肝肝硬化患者95例,根据其是否进展为肝癌分为肝癌组16例和非肝癌组79例.收集并比较两组临床资料,包括性别、年龄、肝癌家族史、病毒学应答(抗病毒治疗6个月时HBV DNA测不出)情况、核苷(酸)类似物耐药情况,以及抗病毒治疗前HBeAg定性检查结果、血清HBV DNA的log10、血清天门冬氨酸氨基转移酶(AST)、血清白蛋白、血小板计数.以两组间比较差异有统计学意义的资料为自变量,以进展为肝癌为因变量,对自变量分别赋值进行COX回归模型分析,确定进展为肝癌的危险因素.结果 两组抗病毒治疗前血清AST水平、抗病毒治疗前血清白蛋白水平、肝癌家族史、核苷(酸)类似物耐药构成比比较P均<0.05,两组年龄及性别男、抗病毒治疗前HBeAg阳性、病毒学应答构成比、抗病毒治疗前血清HBV DNA的log10、抗病毒治疗前血小板计数比较P均>0.05.上述4项有意义的指标纳入多因素COX回归分析结果显示,抗病毒治疗前血清AST水平的HR为12.05,95% CI为2.65~55.56,P=0.001;抗病毒治疗前血清白蛋白水平的HR为1.10,95% CI为0.95~1.27,P=0.201;肝癌家族史的HR为3.51,95% CI为0.80~15.41,P=0.096;核苷(酸)类似物耐药的HR为5.71,95% CI为1.31~24.83,P=0.020.结论 抗病毒治疗前血清AST水平升高和核苷(酸)类似物耐药是接受抗病毒治疗的代偿期乙肝肝硬化患者进展为肝癌的危险因素.
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