慢性丙型肝炎经抗病毒治疗后获得持续病毒学应答患者发生肝细胞癌危险因素预测分析

Risk factors for occurrence of post-sustained virologic response hepatocellular carcinoma in chronic hepatitis C ;patients

目的：研究慢性丙型肝炎（CHC）抗病毒获得持续病毒学应答（SVR）后发生肝细胞癌（HCC）的危险因素和预测模型。方法收集2006年1月至2014年12月郑州大学第一附属医院感染病科因 CHC 入院且抗病毒后获得 SVR 的住院患者共203例，其中 SVR 后 HCC 患者11例；应用 Cox 比例风险回归模型研究 SVR 后 HCC 的危险因素。应用受试者工作特征曲线（ROC）确定危险因素预测SVR 后 HCC 的截断值。结果在 Cox 模型中，与初始诊断 HCV 感染时疾病阶段为 CHC 相比，初始诊断为代偿期肝硬化患者的 SVR 后 HCC 风险增加9．4倍；SVR 时白蛋白水平每升高1 g／L，SVR 后HCC 的风险降低20％。SVR 时白蛋白水平预测 SVR 后 HCC 的截断值为≤36．0 g／L，ROC 曲线下面积为0．809。基于初始诊断 HCV 感染时疾病阶段为代偿期肝硬化和 SVR 时白蛋白≤36．0 g／L 基础上建立了 SVR 后 HCC 预测模型，其 ROC 曲线下面积为0．871，敏感度、特异度和阴性预测值分别为0．818、0．896和0．989。结论初始诊断 HCV 感染时为代偿期肝硬化和 SVR 时白蛋白≤36．0 g／L 是SVR 后 HCC 的危险因素，且可较好地预测 SVR 后 HCC 的发生风险。

Objective To investigate the risk factors and predictive model for the occurrence of post-sustained virologic response （SVR）hepatocellular carcinoma in chronic hepatitis C （CHC）patients. Methods A total of 203 CHC patients hospitalized at the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2014 who received antiviral therapy and achieved SVR were collected,including 11 post-SVR HCC cases.Risk factors for post-SVR HCC were estimated by Cox′s proportional hazards regression model.Cutoff value predicting risk of post-SVR HCC was determined by receiver operating characteristic curve.Results In Cox′s model,the risk of post-SVR HCC increased by 9.4-fold in patients with initial diagnosis as compensated cirrhosis compared to those with initial diagnosis as CHC.Increase in post-SVR albumin by per 1 g/L was associated with reduced risk by 20% for the occurrence of post-SVR HCC.Cut-off value of post-SVR albumin for the prediction of HCC was determined as ≤ 36.0 g/L with an area under the curve （AUC）of 0.809.A predictive model for post-SVR HCC was created based on initial diagnosis as compensated cirrhosis and post-SVR albumin ≤36.0 g/L with an AUC of 0.871 .The sensitivity,specificity and negative predictive value of the model were 0. 818,0.896 and 0.989,respectively.Conclusions Initial diagnosis as compensated cirrhosis combines with post-SVR albumin ≤36.0 g/L are risk factors for post-SVR HCC with ideal prediction value for the occurrence of post-SVR HCC in CHC patients.