经肝动脉化疗栓塞肝细胞癌诱发肝源性糖尿病的危险因素分析

An analysis of clinical factors in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization complicated with diabetes

目的 探讨经肝动脉化疗栓塞（TACE）治疗肝细胞癌（HCC）诱发患者肝源性糖尿病（HD）的临床危险因素.方法 收集2005年11月至2011年12月中山大学附属第一医院48例HCC行TACE后出现HD的患者作为研究组,同期48例HCC行TACE后而无HD的患者为对照组.采用病例-对照研究的方法,对各个研究因素采用逐步引入剔除法,建立logistic回归模型进行各因素系统分析.结果 多因素logistic回归分析显示,HCC患者TACE后发生HD的独立危险因素包括糖尿病家族史（OR=3.464,95％ CI1.100～110.909,P=0.034）、HBV DNA＞1×10^5 IU/ml（OR=5.420,95％ CI1.235～23.792,P=0.025）、肝功能Child-Pugh C级（OR=7.653,95％ CI 1.385～42.301,P =0.020）、肿瘤最大径＞10 cm（OR=5.347,95％ CI1.499 ～ 19.067,P=0.010）、首次栓塞面积＞70％（OR =9.031,95％ CI 1.782～ 48.537,P=0.008）、TACE＞3次（OR =3.726,95％ CI1.151 ～12.065,P=0.028）.结论 糖尿病家族史、HBV DNA＞1×10^5 IU/ml、肝功能Child-Pugh C级、最大肿瘤＞10 cm、首次栓塞面积＞70％、TACE＞3次是HCC患者TACE后易发HD的独立危险因素,有助于早期诊断与治疗.

Objective To investigate related clinical factors of hepatocellular carcinoma （HCC） patients received transcatheter arterial chemoembolization （TACE） complicated with hepatogenous diabetes （HD）.Methods Forty eight cases of HCC line after TACE combined HD patients as the case group,and another forty eight cases of HCC line after TACE without HD patients as control group.A case-control study was retrospectively analyzed among two groups.A logistic regression modelwas established.Results Multivariates analysis showed that family history of diabetes （OR =3.464,95% CI 1.100-10.909,P =0.034）,HBV DNA 〉 1 × 10^5 IU/ml （OR =5.420,95% CI 1.235-23.792,P =0.025）,liver function Child-Pugh C （OR =7.653,95% CI 1.385-42.301,P =0.020）,major larger tumors 〉 10 em （OR =5.347,95% CI 1.499-19.067,P =0.010）,the initial embolism area 〉 70% （OR =9.031,95% CI 1.782-48.537,P =0.008）,TACE 〉 3 times （OR =3.726,95% CI 1.151-12.065,P =0.028） were independent risk factors of HD in patients with HCC after TACE.Conclusion Family history of diabetes,HBV DNA 〉 1 × 105 IU/ml,Child-Pugh C,major tumors size 〉 10 cm,the initial embolism area 〉 70%,TACE 〉 3 times were independent risk factors of HD in HCC patients after TACE.As for factors to these patients,the blood glucose was monitored promptly in order to early diagnosis and treatment.