肝内胆管结石合并肝内胆管癌的危险因素及其对预后的影响

Risk factors of hepatolithiasis combined with intrahepatic cholangiocarcinoma and their impact on prognostic

目的探讨肝内胆管结石合并肝内胆管癌(HL-ICC)发病的危险因素及其对患者预后的影响。方法选取2012年1月至2015年12月郑州大学第一附属医院肝胆胰外科22例HL-ICC患者作为病例组,同期98例单纯肝内胆管结石患者作为对照组,收集两组患者的临床资料,对HL-ICC发生的相关危险因素进行单因素分析及Logistic回归模型多因素分析;对单因素分析中有意义的危险因素采用Log-rank法和Cox风险回归模型行多因素分析,评估其对HL-ICC预后的影响。结果在病例组和对照组的临床症状中只有消瘦(P=0.001)一项具有统计学意义;单因素分析表明,存在统计学意义的危险因素包括糖尿病(P=0.031)、家族肿瘤史(P=0.026)、胆肠吻合术(P=0.026)、乙肝感染(P=0.042)、胆总管结石(P=0.037)、ALP(P=0.035)、LDH(P=0.022)、CA19-9(P=0.003)、CA125(P=0.001)、CEA(P<0.001);Logistic回归模型多因素分析显示糖尿病(OR=5.265,95%CI:1.389～19.954,P=0.015)、胆肠吻合术(OR=13.210,95%CI:2.165～80.667,P=0.005)、CA19-9(OR=1.004,95%CI:1.001～1.007,P=0.010)和CA125(OR=1.024,95%CI:1.001～1.048,P=0.044)是HL-ICC的独立危险因素;Log-rank法检验显示,糖尿病(P=0.031)和CA19-9(P=0.039)与HL-ICC预后相关;Cox风险回归模型进行多因素分析显示,糖尿病(OR=7.623,95%CI:1.896～30.651,P=0.004)和CA19-9(OR=1.002,95%CI:1.000～1.003,P=0.016)是影响HL-ICC预后的独立因素。结论糖尿病、胆肠吻合术、CA19-9和CA125是HL-ICC发生的独立危险因素;糖尿病和CA19-9也是影响HL-ICC预后的独立因素。

Objective To explore the risk factors of hepatolithiasis associated intrahepatic cholangiocarcinoma(HL-ICC)and their impact on prognosis of patients.Methods Clinical data were collected from 22 patients pathologically diagnosed with HL-ICC as case group in the Department of Hepatobiliaryopancreat Surgery,the First Affiliated Hospital of Zhengzhou University from January of 2012 to December of 2015,and 98 patients diagnosed with hepatolithiasis alone in the same time as control group.Univariate analysis and logistic regression analysis were used to test the related risk factors of HL-ICC.Log-rank examination and Cox proportional hazard model were used to assess the impact of risk facts which univariate analysis showed significance on prognosis of HL-ICC.Results Among the clinical symptoms of the case group and the control group,only emaciation(P=0.001)had a statistical significance.Univariate analysis showed that the risk factors with statistical significance included diabetes mellitus(P=0.031),family history of cancer(P=0.026),choledochojejunostomy(P=0.026),hepatitis B virus(HBV)infection(P=0.042),choledocholithiasis(P=0.037),ALP(P=0.035),LDH(P=0.022),CA19-9(P=0.003),CA125(P=0.001)and CEA(P<0.001).The results of Logistic regression analysis demonstrated that diabetes mellitus(OR=5.265,95%CI:1.389-19.954,P=0.015),choledochojejunostomy(OR=13.210,95%CI:2.165-80.667,P=0.005),CA19-9(OR=1.004,95%CI:1.001-1.007,P=0.010)and CA125(OR=1.024,95%CI:1.001-1.048,P=0.044)were independent risk factors for HL-ICC.Significant correlation was found between diabetes mellitus(P=0.031),CA19-9(P=0.039)and prognosis of HL-ICC according to the Log-rank examination.The Cox proportional hazard model showed that diabetes mellitus(OR=7.623,95%CI:1.896-30.651,P=0.004)and CA19-9(OR=1.002,95%CI:1.000-1.003,P=0.016)were independent risk factors for prognosis of HL-ICC.Conclusion Diabetes mellitus,choledochojejunostomy,CA19-9 and CA125 were independent risk factors for HL-ICC.Diabetes mellitus and CA19-9 were also independent prognostic factors for HL-ICC.