2型糖尿病对乙型肝炎相关性肝癌病人预后的影响

Effect of type 2 diabetes mellitus on the prognosis of patients with hepatocellular carcinoma associated with hepatitis B virus

目的分析乙型肝炎相关性肝癌病人合并2型糖尿病(T2DM)与否对其预后的影响。方法收集2018年8月至2021年6月在徐州医科大学附属医院就诊的429例乙肝相关性肝癌病人,根据是否合并T2DM,将其分为T2DM组(167例)和非T2DM组(262例)。比较两组病人的临床特征及预后情况。符合正态分布的计量资料组间比较采用独立样本t检验,非正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ^(2)检验或Fisher确切概率法。采用Kaplan-Meier法及Log-rank绘制生存曲线,Cox比例风险回归模型进行单或多因素分析。P<0.05为差异有统计学意义。结果乙肝相关性肝癌病人多因素Cox回归分析显示T2DM是影响其预后的危险因素[HR=1.38,95%CI:(1.08,1.76),P<0.05]。T2DM组的生存时间为10.0(2.0,27.0)个月显著低于非T2DM组的21.0(6.0,35.0)个月,差异有统计学意义(P<0.05)。T2DM组第1、2、3年的累积生存率(46.7%、34.4%、25.5%)显著低于非T2DM组(61.0%、45.3%、31.3%),差异有统计学意义(P<0.05)。T2DM亚组分析显示:糖尿病病程≥10年组累积生存率低于糖尿病病程<10年组(P=0.009),HbA1c>7.4%组的累积生存率低于HbA1c≤7.4%组(P=0.024)。合并T2DM的乙肝相关性肝癌病人多因素Cox回归分析显示:糖尿病病程≥10年[HR=1.62,95%CI:(1.12,2.35)]、AFP≥400μg/L[HR=1.60,95%CI:(1.04,2.48)]和肝癌保守治疗(HR>1,P<0.05)是其预后的危险因素。结论T2DM是影响乙肝相关性肝癌病人预后的危险因素,且糖尿病病程≥10年、AFP≥400μg/L和肝癌保守治疗的病人预后风险越大。

Objective To analyze the influence of type 2 diabetes mellitus(T2DM)on the prognosis of patients with hepatitis B-related hepatocellular carcinoma.Methods From August 2018 to June 2021,429 patients with HBV-related HCC in the Affiliated Hospital of Xuzhou Medical University were divided into the T2DM group(n=167)and non-T2DM group(n=262)according to whether they had T2DM or not.The clinical features and prognosis were compared between the two groups.The measurement data in normal distribution were compared by independent sample t-test,the measurement data in non-normal distribution were compared by Mann-Whitney U test,and the enumeration data were compared by chi-square test or Fisher exact probability method.Kaplan-Meier and Log-rank methods were used to draw survival curves,and Cox proportional hazard regression model was used to analyze single or multiple factors.The difference was statistically significant when P<0.05.Results Multivariate Cox regression analysis showed that T2DM was a risk factor for the prognosis of HBV-related HCC[HR=1.38,95%CI:(1.08,1.76),P<0.05].The median survival time in the T2DM group was 10.0(2.0,27.0)months,which was significantly lower than that in the non-T2DM group 21.0(6.0,35.0)months(P<0.05).The 1,2,and 3-year cumulative survival rates in the T2DM group(46.7%,34.4%,and 25.5%)were significantly lower than those in the non-T2DM group(61.0%,45.3%,and 31.3%)(P<0.05).T2DM subgroup analysis showed that the cumulative survival rate of patients with diabetes duration≥10 years was lower than that of patients with diabetes duration<10 years(P=0.009),and the cumulative survival rate of HbA1c>7.4%group was lower than that of HbA1c≤7.4%group(P=0.024).Multivariate Cox regression analysis showed that duration of diabetes mellitus≥10 years[HR=1.62,95%CI:(1.12,2.35)],AFP≥400μg/L[HR=1.60,95%CI:(1.04,2.48)],and conservative treatment(HR>1,P<0.05)were the risk factors for prognosis.Conclusion T2DM is a risk factor for the prognosis of patients with HBV-related HCC,and patients with a duration of diabetes≥10 years,AFP≥400μg/L,and conservative treatment of HCC have a greater risk of prognosis.