代谢综合征与乙型肝炎病毒相关性肝细胞癌预后的危险因素分析

Risk factors for the prognosis of metabolic syndrome and hepatitis B virus related hepatocellular carcinoma

目的分析代谢综合征(MetS)与乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)关联,以及各代谢因素对疾病进展及预后的影响。方法收集2012年7月至2021年6月中山大学附属第八医院(深圳福田)收治的177例HCC合并HBV感染患者临床资料,根据是否合并MetS分为MetS+组(合并MetS)和MetS-组(未合并MetS)。收集患者的性别、年龄、实验室指标、肿瘤肝内转移、血管侵犯、肿瘤大小、淋巴结转移及远处转移情况进行对比,分析两组HCC患者的肿瘤进展差异,单因素和多因素Logistic回归分析MetS各代谢因素对HCC进展的影响。以Cox回归模型和Kaplan-Meier曲线进行生存分析。结果MetS+组76例(42.9%),MetS-组101例(57.1%)。MetS+组的肿瘤肝内转移发生率显著高于MetS-组(53.9%vs 28.7%,χ2=11.551,P=0.001);多因素Logistic回归分析显示,血糖升高是影响HBV相关性HCC发生肝内转移的独立危险因素(OR=2.636,95%CI:1.356~5.126,P=0.004)。Cox回归模型分析显示,血糖升高患者死亡风险显著升高,相对危险度为2.081(P=0.006)。Kaplan-Meier曲线分析显示,血糖正常组患者总体生存显著优于血糖升高组,血糖升高患者预后较差(χ2=6.190,P=0.013)。结论MetS促进HBV相关性HCC的肝内转移,其代谢因素中血糖升高是促进肿瘤进展和肝内转移的独立危险因素,可增加HBV相关性HCC患者的死亡风险。

Objective To analyze the relationship between metabolic syndrome(MetS)and hepatitis B virus(HBV)related hepatocellular carcinoma(HCC),and the infl uence of metabolic factors on disease progression and prognosis.Methods From July 2012 to June 2021,the clinical data of 177 patients with chronic HBV related HCC admitted to the Eighth Affiliated Hospital,Sun Yat-sen University were collected.According to whether MetS was combined,they were divided into MetS+group and MetS-group.The gender,age,laboratory indicators,intrahepatic metastasis,vascular invasion,tumor size,lymph node metastasis and distant metastasis of the patients were compared,and the difference in tumor progression between the two groups was analyzed.Univariate and multivariate Logistic regression analysis were used to analyze the influence of metabolic factors of MetS on the progress of HCC.Cox regression model and Kaplan-Meier curve was used for survival analysis.Results There were 76 cases(42.9%)in MetS+group and 101 cases(57.1%)in MetS-group.The rate of intrahepatic metastasis in the MetS+group was signifi cantly higher than that in the MetS-group(53.9%vs 28.7%,χ2=11.551,P=0.001).Elevated blood glucose was an independent risk factor for intrahepatic metastasis of HBV related HCC(OR=2.636,95%CI:1.356-5.126,P=0.004).Cox regression model analysis showed that the risk of death in HCC patients with elevated blood glucose was signifi cantly increased and the relative risk was 2.081(P=0.006).Kaplan-Meier curve showed that the overall survival of patients with normal blood glucose was signifi cantly better than those with elevated blood glucose,poorer prognosis in patients with elevated blood glucose(χ2=6.190,P=0.013).Conclusions MetS promotes the intrahepatic metastasis of HBV related HCC.Among its metabolic factors,elevated blood glucose is an independent risk factor for tumor progression and intrahepatic metastasis of HCC,which increases the death risk of patients with HBV related HCC.