肝细胞癌患者TACE治疗后新发心血管疾病的危险因素分析

Analysis of risk factors of new cardiovascular disease in patients with hepatocellular carcinoma after TACE treatment

目的 探讨经导管动脉化疗栓塞(TACE)治疗后肝细胞癌患者6个月内发生心血管疾病的危险因素。方法 回顾性分析2020年5月1日至2023年6月30日在新乡医学院第一附属医院接受TACE治疗的155例肝细胞癌患者的临床数据。排除不完整资料及失访患者后,纳入105例患者进行分析。根据患者TACE治疗后是否发生心血管疾病分为两组,通过多因素分析确定独立危险因素。结果 105例肝细胞癌患者共有29例在6个月内发生心血管疾病,占比27.6%。随访发现,29例患者均出现不同程度的心律失常。另外,这些心律失常的患者有8例在TACE治疗后第2~8周出现心绞痛,5例在第3~12周发生心力衰竭,3例在第13~24周发生心肌炎,2例在第2周发生急性心肌梗死,占心血管疾病总例数的62.1%。独立危险因素包括肝功能B级、糖尿病、高脂血症、TACE治疗次数超过3次及未规律运动(OR> 1且P <0.05)。多因素联合预测的受试者工作特征曲线下面积值为0.782(95%CI:0.683~0.882),显示出良好的预测效能。结论 TACE治疗后肝细胞癌患者的心血管疾病风险应引起重视。对于存在相关风险因素的患者,应积极控制基础疾病并增加体力活动。

Objective To explore the risk factors of cardiovascular diseases in patients with hepatocellular carcinoma within 6 months after transcatheter arterial chemoembolization(TACE).Methods The clinical data of 155 hepatocellular carcinoma patients treated with TACE in the First Affiliated Hospital of Xinxiang Medical University from May 1,2020 to June 30,2023 were analyzed retrospectively.After the exclusion of incomplete data and lost patients,a total of 105 patients were included for analysis.Patients were divided into two groups according to whether cardiovascular disease occurred after TACE treatment,and independent risk factors were determined by multivariate analysis.Results Among the 105 hepatocellular carcinoma patients,29(27.6%)developed cardiovascular disease within six months.Follow-up revealed that 29 patients developed various degrees of arrhythmias.In addition,8 of these patients with arrhythmias developed angina pectoris between weeks 2 and 8 after TACE,5 patients developed heart failure between weeks 3 and 12,3 patients developed myocarditis between weeks 13 and 24,and 2 patients developed acute myocardial infarction at week 2,accounting for 62.1%of total cardiovascular disease cases.Independent risk factors included liver function grade B,diabetes,hyperlipidemia,TACE treatment for more than 3 times and irregular exercise(OR>1 and P<0.05).The area under the curve value of the receiver operating characteristic predicted by multi-factors was 0.782(95%CI:0.683-0.882),which showed good prediction efficiency.Conclusion The risk of cardiovascular disease in patients with hepatocellular carcinoma after TACE should be paid attention.For patients with related risk factors,we should actively control the basic diseases and increase physical activity.