核苷(酸)类似物抗病毒治疗慢性乙型肝炎患者发生原发性肝癌的危险因素分析

Risk factors for hepatocellular carcinoma among patients with chronic hepatitis B in the era of nucleos(t)ide analogues treatment

目的分析抗病毒治疗慢性乙型肝炎(CHB)患者发生原发性肝癌(HCC)的危险因素。方法采用问卷调查法采集2013年3月至2017年9月在解放军第四一三医院感染科就诊的285例CHB患者临床转归及相关因素等资料,行单因素及多因素分析以评估CHB患者发生HCC的危险因素。结果单因素分析显示,男性、年龄>40岁、未抗病毒治疗、肝硬化程度、高HBV DNA水平、有HCC家族史在CHB患者HCC发生方面差异有统计学意义(P<0.05);将上述因素纳入多因素Logistic回归分析显示,年龄>40岁(OR=3.318,P=0.019)、未抗病毒治疗(OR=2.709,P=0.002)、有HCC家族史(OR=2.096,P=0.037)、肝硬化程度为CHB患者发生HCC的主要危险因素。肝硬化患者中Child-Pugh C级、Child-Pugh B级、Child-Pugh A级与无肝硬化相比,HCC发生风险均显著升高(OR值分别为18.453、13.395、6.970,P=0.000)。结论年龄>40岁、肝硬化程度、未抗病毒治疗和有HCC家族史是发生HCC的主要危险因素,对于具有上述危险因素的人群应及时启动抗病毒治疗并加强随访工作。

Objective To analyze risk factors for hepatocellular carcinoma(HCC)among patients with chronic hepatitis B(CHB)in the era of continuous treatment with nucleos(t)ide analogues.Methods In this study,questionnaire survey was used to collect the clinical data of 285 patients with CHB enrolled in Department of Infectious Diseases tn 413 Military Hospital from March 2013 to September 2017.Risk factors for HCC were identified by univariate and multivariate analysis.Results Univariate analysis showed that gender,age,antiviral treatment,cirrhosis statue,serum hepatitis B virus(HBV)DNA level,and HCC family history were correlated with development of HCC among patients with CHB(P<0.05).Furthermore,multivariate logistic regression analysis showed that age older than 40 years(OR=3.318,P=0.019),no antiviral therapy(OR=2.709,P=0.002),HCC family history(OR=2.096,P=0.037),and cirrhosis were the main risk factors for HCC development.Child-Pugh C,B andApatients with cirrhosis all had signiticantly higher risk ofHCC than thosewithout cirrhosis(OR-C=18.453,OR-B=13.395,OR-A=6.970,P=0.000).Concision Age older than 40 years,cirrhosis statue,no antiviral treatment,family history of HCC are major risk factors for HCC development.Patients with risk factors should receive prompt antiviral treatment and be closely followed up.