慢性丙型肝炎持续病毒学应答后发生肝癌患者的临床特征分析

Clinical characteristics analysis of hepatocellular carcinoma in chronic hepatitis C patients with a sustained virologic response

目的 研究抗HCV治疗后获得持续病毒学应答（SVR）发生肝癌（HCC）患者的临床特征。方法收集2006年至2014年郑州大学第一附属医院感染病科因慢性丙型肝炎入院抗病毒后获得SVR且未发生HCC的住院患者192例，SVR后发生HCC患者11例，分析两组患者临床特征的差异。结果HCC组随访中位时间为17（10-39）个月，无HCC组为50（33～63）个月。HCC组初始诊断HCV感染时以及抗病毒时疾病所处的阶段为代偿期肝硬化所占比例显著高于无HCC组（54．5％比4．2％，P＜0．01；63．6％比16．7％，P：0．001）；HCC组病毒性肝炎家族史的比例显著高于无HCC组（100％比10．4％，P〈0．01）；HCC组SVR时白蛋白水平显著低于无HCC组[（35．0±6．0）g／L比（41．3±4．7）g／L，P=0．001]；HCC组SVR时甲胎蛋白水平显著高于无HCC组[（29．8±3．2）ng／mL比（5．7±4．4）ng／mL，P〈0．01]。结论初始诊断HCV感染时和抗病毒时患者为代偿期肝硬化、病毒性肝炎家族史、SVR时低白蛋白水平以及SVR时较高甲胎蛋白水平可能是慢性丙肝患者sVR后HCC的危险因素。

Objective To investigate the clinical characteristics of hepatocellular carcinoma （HCC） in chronic hepatitis C （CHC） patients who had achieved a sustained virologic response （post-SVR HCC） to antivirus therapy. Methods Two hundred and three SVR-aehieving CHC inpatients in first affiliated hospital of Zhengzhou University from 2006 to 2014, including 192 post-SVR non-HCC cases （control group） and 11 post-SVR HCC cases （case group）, were enrolled to analyze their clinical characteristics. Results The median follow-up periods of case group and control group were 17.0 （10.0-39. 0） and 50. 0 （33. 0-63. 0） months, respectively. When compared to those in control group, there were significantly higher rates of preliminary diagnosis as compensated cirrhosis and antiviral therapy initiated in compensated cirrhosis in case group （54. 5 % vs. 4. 2%, P〈0. 001 63.6%vs. 16. 7%, P = 0. 001）, higher proportion of family history of hepatitis （100M vs. 10.4%, P〈0. 001）, lower post-SVR albumin level （35.0 ±6. 0 g/L vs. 41.3 ±4. 7 g/L, P = 0. 001）, higher post-SVR alpha fetal protein level （AFP） in case group （29. 8 ± 3.2 ng/mL vs. 5.7 ± 4.4 ng/mL, P〈 0. 001 ）, respectively. Conclusion Preliminary diagnosis as compensated cirrhosis, antiviral therapy initiated in compensated cirrhosis, family history of hepatitis, low post-SVR albumin level and high post-SVR AFP level may be risk factors for the occurrence of HCC in CHC patients who had achieved SVR to anti-HCV therapy.