乙肝肝硬化患者并发肝癌的危险因素研究

Prospective analysis of risk factors for the occurrence of hepatocellular carcinoma in patients with post-hepatitis B cirrhosis

探讨乙型肝炎肝硬化患者短期内原发性肝癌的发生情况及其发生的危险因素。对180例乙型肝炎肝硬化患者作了4年随访,应用Kaplan-Meier法计算其原发性肝癌的发生情况,Cox风险模型分析发生原发性肝癌的独立的危险因素。共有30例并发原发性肝癌,第一年肝癌的发病率为2.2%,第二年为5.5%,第三年为5.7%,第四年为6.8%。平均每年发病率为4.8%。并发原发性肝癌的危险因素有以下几个:年龄大于50岁、有长期饮酒史(饮酒量大于75g/天)、有出血史、甲胎蛋白大于50μg/L、凝血酶原活动度小于70%、血小板计数小于60×109/、凝血酶原活动度小于70%为独立的危险因素。根据独立的危险因素可建立并发原发性肝癌的预测公式,其预测值为0-4.84。预测值大于2.57的患者为发生原发性肝癌的高风险人群,其4年中肝癌的累积发生率为61%。预测值小于2.57的患者为低风险人群,其4年中肝癌的累积发生率为8.1%。

To elucidate the occurrence rate of hepatocellar carcinoma in patients with post -hepatitis B cirrhosis, and to assess the risk factors for hepatocellular carcinoma（ HCC ）. A total of 180 patients had been prospectively invested for four years. The occurrence rate of HCC was calculated with Kaplan - Meier method. And the risk factors of HCC were evaluated with Cox regression model. During observation period, the HCC were developed in 30 patients. With multivariate analysis, 4 variables, age （50 years or older）, prothrombin activity （70% or less）, platelet count （less than 60 × 10^9/L）, and α -fetopreotein level （50ng/L or higher） , were showed to be independent predictive values for the development of HCC. According to the contribution of each of these factors to the final model, a score ranging from 0 to 4. 84 was used for division of patients into 2 different risk groups. The lower risk group included those with score of 2. 57 or less （ n = 99,8 cases with HCC, cumulative incidence of HCC at 4 years was 8. 1% ）. While the higher risk group included those with score greater than 2. 57（n =33, 22 cases with HCC, cumulative incidence of HCC at 4 years was 61% ） （P=0. 00012）.