高原地区原发性肝癌患者癌块自发破裂出血的影响因素分析

Factors of spontaneous tumor rupture and bleeding in patients with primary hepatocellular carcinoma in the Plateau Area

目的分析高原地区原发性肝癌患者癌块自发破裂出血的影响因素。方法选取2018年5月至2022年1月于拉萨市人民医院接受治疗的原发性肝癌患者123例,根据癌块是否自发破裂出血分为破裂出血组60例和未破裂出血组63例,分析对比两组的临床资料。结果与未破裂出血组相比,破裂出血组患者平均生活海拔更高、肿瘤最大直径更大、腹腔积液量更多、Child-Pugh分级更差,谷草转氨酶水平更高,凝血酶原时间更长,国际标准化比值更高,并发门静脉高压与门静脉癌栓比例更高,其差异有显著性(P<0.05)。多因素logistic回归分析结果显示,平均生活海拔大于3000m、肿瘤最大直径大于5cm、大量腹腔积液量、Child-Pugh分级C级、谷草转氨酶>2倍正常值、凝血酶原时间延长2s以上、国际标准化比值>1.2是高原地区肝癌患者发生癌块破裂出血的独立危险因素(P<0.05)。结论对于高原地区肝癌患者,临床医师应结合生活海拔、肿瘤直径、腹腔积液量、Child-Pugh分级、谷草转氨酶、凝血酶原时间、国际标准化比值等独立危险因素,评估其癌块破裂出血的风险,并及时予以相应预防措施降低出血风险。

Objective To analyze the influencing factors of tumor rupture and bleeding in patients with primary liver cancer at high altitude.Method 123 patients with primary liver cancer who were treated in Lhasa People’s Hospital from May 2018 to January 2022 were selected.They were divided into the ruptured bleeding group(60 cases)and the unruptured bleeding group(63 cases),according to whether the tumor was ruptured and bleeding.The clinical data of the two groups were analyzed and compared.Result Compared with the unruptured bleeding group,the patients in the ruptured bleeding group had higher average living altitude,larger maximum tumor diameter,more peritoneal effusion,worse child Pugh grade,higher aspartate aminotransferase value,more prolonged prothrombin time and higher international normalized ratio.In addition,more complications,including portal hypertension and portal vein tumor thrombus,were brought.The two groups have a significant difference(P<0.05).According to multivariate logistic regression analysis,the average living altitude was more than three km,the maximum diameter of the tumor was more than five cm,the amount of large peritoneal effusion,the child Pugh grade C,the aspartate aminotransferase was more than two times the normal value,the prothrombin time was prolonged for more than two seconds,and the international normalized ratio was more than 1.2.These were the independent risk factors for the rupture and bleeding of the tumor in the patients with liver cancer at high altitude(P<0.05).Conclusion For the patients with liver cancer at high altitude,clinicians should evaluate the risk of rupture and bleeding of tumor in combination with the above independent risk factors,and take corresponding preventive measures in time to reduce the bleeding risk.