慢性丙型肝炎病毒感染患者获得持续病毒学应答后肝细胞癌发生的危险因素

Risk factors for hepatocellular carcinoma after sustained virologic response in patients with chronic hepatitis C virus infection

目的探讨慢性丙型肝炎病毒(hepatitis C virus, HCV)感染患者进行抗病毒治疗获得持续病毒学应答(sustained virologic response, SVR)后肝细胞癌发生的危险因素。方法纳入2012年1月至2019年4月在天津市第二人民医院治疗的慢性HCV感染患者, 回顾性分析其肝细胞癌新发情况。采用Cox比例风险模型筛选影响患者发生肝细胞癌的危险因素。结果 644例慢性HCV感染患者中, 慢性丙型肝炎421例(65.4%), 丙型肝炎肝硬化223例(34.6%), 新发肝细胞癌34例, 均发生于肝硬化患者。Cox比例风险多因素分析显示:Child-Pugh分级B级以上[风险比(hazard ratio, HR)=6.050, 95%可信区间(confidence interval, CI) 2.658~13.771,P<0.001]、饮酒史(HR=3.077, 95%CI 1.428~6.634, P=0.004)、恶性肿瘤家族史(HR=2.376, 95%CI 1.155~4.888, P=0.019)、年龄≥60岁(HR=3.301, 95%CI 1.563~6.974, P=0.002)、受控衰减参数>292 dB/m(HR=3.842, 95%CI 1.543~9.565, P=0.004)是肝细胞癌的危险因素。结论慢性丙型肝炎尤其是肝硬化患者获得SVR后仍有发生肝细胞癌的风险。对于年龄≥60岁、Child-Pugh分级B级以上、存在重度脂肪肝、有饮酒史或恶性肿瘤家族史等高危因素的患者, 更需加强肝细胞癌监测。

Objective To investigate the risk factors for hepatocellular carcinoma(HCC)after sustained virologic response(SVR)in patients with chronic hepatitis C virus(HCV)infection.Methods Patients with chronic HCV infection who were treated in Tianjin Second People′s Hospital from January 2012 to April 2019 were enrolled and the incidence of new HCC was retrospectively analyzed.Cox proportional hazards model was used to analyze the risk factors for HCC.Results Among the 644 patients with chronic HCV infection,421 cases(65.4%)had chronic hepatitis C(CHC),223 cases(34.6%)had hepatitis C cirrhosis,and 34 cases had new HCC.No patient without cirrhosis developed HCC.Cox proportional hazards multivariate analysis showed that Child-Pugh grade B or above(hazard ratio(HR)=6.050,95%confidence interval(CI)2.658 to 13.771,P<0.001),drinking history(HR=3.077,95%CI 1.428 to 6.634,P=0.004),family history of cancer(HR=2.376,95%CI 1.155 to 4.888,P=0.019),age≥60 years old(HR=3.301,95%CI 1.563 to 6.974,P=0.002),controlled attenuation parameter>292 dB/m(HR=3.842,95%CI 1.543 to 9.565,P=0.004)were risk factors for HCC.Conclusions Patients with CHC,especially cirrhosis,are still at risk of HCC post-SVR.HCC monitoring should be strengthened for individuals over 60 years of age,Child-Pugh grade B or above,with severe fatty liver disease,drinking history or family history of malignancy.