应用aMAP评分评估基层医院慢性肝病人群的肝癌发生风险

Application of aMAP score to assess the risk of hepatocarciongenesis in population of chronic liver disease in primary hospitals

目的aMAP评分是依托国际合作队列构建的可适用于各种肝病的肝细胞癌(HCC)风险预测模型。本研究拟运用aMAP评分对江西省赣州市于都县人民医院接诊的慢性肝病患者(合并或未合并代谢性疾病)进行HCC风险分层,以期指导个体化HCC筛查。方法收集于都县人民医院于2016年1月至2020年12月接诊的慢性肝病患者的人口统计学信息、实验室检验结果(血小板、白蛋白和总胆红素)及合并疾病信息,并计算aMAP评分,对该人群进行HCC风险分层。结果共计3629例慢性肝病患者纳入分析,其中乙型肝炎病毒(HBV)感染患者3452例(95.1%),脂肪肝患者177例(4.9%),HBV感染合并脂肪肝22例(0.6%);男性2679例(73.8%),中位数年龄44(35,54)岁。在总体人群中,HCC低、中和高风险人群分别占52.6%、29.0%和18.4%;在HBV感染人群中,HCC高风险人群的比例显著高于脂肪肝人群(18.9%对比9.6%,P=0.001)。合并高血压或糖尿病的慢性肝病人群,其HCC高风险人群比例显著高于未合并上述代谢性疾病人群(合并高血压:32.3%对比17.9%,P<0.001;合并糖尿病:36.5%对比18.1%,P<0.001)。而且,合并两种代谢性疾病人群的HCC高风险人群比例显著高于合并一种及未合并代谢性疾病的人群(40.9%对比31.8%对比17.7%,P<0.001)。结论aMAP评分可作为基层医院慢性肝病HCC筛查管理的简便工具,有助于健全慢性肝病人群个体化随访管理体系。合并代谢性疾病的慢性肝病患者具有更高HCC发生风险,应在后续随访中给予HCC高风险人群重点关注,从而提高HCC早诊率、降低死亡率。

Objective The aMAP score is a hepatocellular carcinoma(HCC)risk prediction model based on an international cooperative cohort,which can be applied to various liver diseases.The aim of this study is to use the aMAP score to stratify the risk of HCC in patients with chronic liver disease(combined or non-combined metabolic diseases)admitted to People's Hospital of Yudu County,Ganzhou City,Jiangxi Province,in order to guide personalized HCC screening.Methods The demographic information,laboratory test results(platelets,albumin,and total bilirubin)and combined disease information of patients with chronic liver disease who were admitted to People's Hospital of Yudu from January 2016 to December 2020 were collected,and the aMAP score was calculated to stratify HCC risk in this population.Results A total of 3629 cases with chronic liver disease were included in the analysis,including 3452(95.1%)cases with hepatitis B virus(HBV)infection,177(4.9%)cases with fatty liver,and 22(0.6%)cases with HBV infection and fatty liver.There were 2679(73.8%)male and the median age was 44(35,54).In the overall population,low,medium and high risk of HCC accounted for 52.6%,29.0%,and 18.4%respectively.In the HBV-infected population,the proportion of high risk of HCC was significantly higher than that of fatty liver(18.9%vs.9.6%,P=0.001).The proportion of chronic liver disease patients with combined hypertension or diabetes was significantly higher than that of those with non-combined metabolic diseases(combined hypertension:32.3%vs.17.9%,P<0.001;combined diabetes:36.5%vs.18.1%,P<0.001).Moreover,the proportion of high-risk population with two metabolic diseases was significantly higher than that with one and no metabolic diseases(40.9%vs.31.8%vs.17.7%,P<0.001).Conclusion The aMAP score can be used as a simple tool for HCC screening and management of chronic liver disease in primary hospitals,and it is helpful to improve the personalized follow-up management system of chronic liver disease population.Chronic liver disease patients with metabolic diseases have a higher risk of HCC,and people with high risk of HCC should be given special priority in follow-up visits,so as to improve the rate of HCC early diagnosis and reduce the mortality rate.