合并高血压病的乙型肝炎肝硬化患者发生肝细胞癌的风险评估:一项基于倾向性匹配评分的回顾性队列研究

Risk assessment of hepatocellular carcinoma in patients with hepatitis B-related cirrhosis and hypertension:a propensity score matching-based retrospective cohort study

目的阐明慢性乙型肝炎肝硬化(CHB-Cir)患者合并高血压病(EH)时发生肝细胞癌(HCC)的风险及其协同因素,探讨高血压病对慢性乙型肝炎肝硬化患者的影响。方法以2017年1月~2024年1月在新乡医学院第三附属医院感染科随访的经抗病毒治疗的CHB-Cir患者为研究对象,形成CHB-Cir合并EH队列和CHB-Cir无EH队列,排除随访时间过短及主要数据缺失的病例,将两组队列中的患者进行倾向性匹配评分后构成EH组和无EH组,采用Kaplan-Meier法比较两组HCC累积发生率;以Cox比例风险回归模型分析CHB-Cir合并EH时发生HCC的风险及其协同因素。结果高血压病与肝细胞癌的发生显著相关(HR=1.69,P=0.002),在多因素分析中,男性(HR=1.73,P=0.005)、肝癌家族史(HR=2.23,P<0.001)、甲胎蛋白升高(HR=2.83,P=0.001)、谷胱甘肽还原酶升高(HR=1.53,P=0.046)、高密度脂蛋白降低(HR=1.46,P=0.027)、低密度脂蛋白升高(HR=2.29,P=0.003)与肝细胞癌的发生相关,甘油三酯升高(HR=0.37,P<0.001)为肝细胞癌发生的保护因素。在EH组中,非RASIs药物治疗(HR=2.77,P=0.021)、未治疗/利尿剂治疗(HR=7.18,P<0.001)与肝细胞癌的发生相关。结论高血压病及其特征增加了慢性乙型肝炎肝硬化患者发生肝细胞癌的风险。对这些患者应该强调高血压病控制的重要性。

Objective To analyze the factors affecting the risk of hepatocellular carcinoma(HCC)in patients with chronic hepatitis B-associated cirrhosis(CHB-Cir)complicated by essential hypertension(EH)and explore the impact of EH on HCC risk in patients with CHB-Cir.Methods This study was conducted among the patients with CHB-Cir with or without EH received antiviral therapy in the Infectious Disease Department,Third Affiliated Hospital of Xinxiang Medical University from January,2017 to January,2024.The cases with insufficient follow-up time or missing data were excluded.The patients were subjected to propensity score matching in a 1:1 ratio to form an EH group and a non-EH group.The Kaplan-Meier method was used to compare the cumulative incidence of HCC between the two groups,and the Cox proportional hazards regression model was used to analyze the risk of HCC and the factors affecting HCC risk.Results A total of 390 CHB-Cir patients(274 male and 116 female patients)were enrolled in this study,including 195 with EH and 195 without EH.In these patients,EH was significantly correlated with the occurrence of HCC(HR=1.69,P=0.002).Multivariate analysis suggested that the male gender(HR=1.73,P=0.005),a family history of liver cancer(HR=2.23,P<0.001),elevated alpha-fetoprotein(HR=2.83,P=0.001),elevated glutathione reductase(HR=1.53,P=0.046),reduced high-density lipoprotein(HR=1.46,P=0.027),and elevated low-density lipoprotein(HR=2.29,P=0.003)were all significantly correlated with HCC occurrence,while elevated triglycerides(HR=0.37,P<0.001)was a protective factor against HCC.In the EH group,treatment with non-RASIs drugs(HR=2.77,P=0.021)and no treatment/diuretic treatment(HR=7.18,P<0.001)were significantly correlated with HCC occurrence.Conclusion Hypertension increases the risk of HCC in patients with CHB-Cir,suggesting the importance of controlling hypertension in these patients.