摘要
目的分析乙型肝炎病毒(hepatitis B virus,HBV)相关肝细胞癌患者并发上消化道出血的影响因素。方法选取2014年1月至2017年12月于深圳市第三人民医院确诊的135例HBV相关肝细胞癌患者进行回顾性分析,根据患者是否发生上消化道出血分为出血组(45例)和对照组(90例),比较两组患者的临床特征和转归。具体指标包括年龄、性别、是否抗病毒治疗、HBV DNA、血小板(blood platelet,PLT)、白蛋白(albumin,ALB)、凝血酶原时间(prothrombin time,PT)、脾脏厚度、门静脉癌栓、食管胃底静脉曲张、红色征、门脉高压性胃病、腹水、腹膜炎、肝性脑病和肝肾综合征。采用Logistic多因素回归分析HBV相关肝细胞癌并发上消化道出血的影响因素。结果出血组与对照组患者HBV DNA阳性率(77.8%vs 66.7%)和PLT计数(中位数:147.87×10^(9)/L vs 148.51×10^(9)/L)差异无统计学意义(χ^(2)=1.776,P=0.183;U=2009.500,P=0.942)。出血组患者ALB水平显著低于对照组[(31.47±6.64)g/L vs(36.24±7.04)g/L],PT显著长于对照组(中位数:17.85 s vs 16.91 s),脾脏厚度较对照组增厚[(47.98±10.93)mm vs(43.71±11.45)mm],差异均有统计学意义(t=-3.787,P<0.001;U=221.500,P<0.001;t=2.072,P=0.040)。出血组患者门静脉癌栓(73.3%vs 40.0%)、食管胃底静脉曲张(71.1%vs 46.7%)、红色征阳性(42.2%vs 6.7%)、门脉高压性胃病(48.9%vs 12.2%)、腹水(77.8%vs 44.4%)、腹膜炎(55.6%vs 22.2%)、肝性脑病(17.8%vs 3.3%)和肝肾综合征(17.8%vs 2.2%)发生率均显著高于对照组,差异有统计学意义(P均<0.05)。Logistic多因素回归分析表明,ALB(OR=0.912,95%CI:0.852~0.977,P=0.008)、红色征(OR=8.551,95%CI:2.808~26.036,P<0.001)、门静脉癌栓(OR=4.368,95%CI:1.761~10.834,P=0.001)、腹膜炎(OR=4.135,95%CI:1.877~9.109,P<0.001)和肝性脑病(OR=5.466,95%CI:1.282~23.313,P=0.022)是HBV相关肝细胞癌并发上消化道出血的独立影响因素,其中ALB为保护性因素,红色征为最主要的独立危险因素。出血�
Objective To analyze the influencing factors of patients with hepatitis B virus(HBV)-related hepatocellular carcinoma complicated with upper gastrointestinal bleeding.Methods A total of 135 cases with HBV-related hepatocellular carcinoma in Shenzhen Third People’s Hospital from January 2014 to December 2017 were retrospectively analyzed and divided into bleeding group(45 cases)and control group(90 cases)according to whether complicated with upper gastrointestinal bleeding.The clinical features and outcomes of patients in both groups were compared.The indexes included age,gender,antiviral therapy,HBV DNA,blood platelet(PLT),albumin(ALB),prothrombin time(PT),spleen thickness,portal vein tumor thrombus,esophageal and gastric varices,red sign,portal hypertensive gastropathy,ascites,peritonitis,hepatic encephalopathy and hepatorenal syndrome.The independent influencing factors of HBV-related hepatocellular carcinoma complicated with upper gastrointestinal bleeding were analyzed by Logistic multivariate regression analysis.Results There were no statistically significant differences of HBV DNA positive rate(77.8%vs 66.7%)and PLT count(median:147.87×10^(9)/L vs 148.51×10^(9)/L)of patients in bleeding group and control group(χ^(2)=1.776,P=0.183;U=2009.500,P=0.942).ALB level of patients in bleeding group was lower than that in control group[(31.47±6.64)g/L vs(36.24±7.04)g/L],the level of PT was longer than that of control group(median:17.85 s vs 16.91 s)and the spleen was thicker than that of control group[(47.98±10.93)mm vs(43.71±11.45)mm],the differences were statistically significant(t=-3.787,P<0.001;U=221.500,P<0.001;t=2.072,P=0.040).The incidence of portal vein tumor thrombus(73.3%vs 40.0%),esophageal and gastric varices(71.1%vs 46.7%),red sign positive(42.2%vs 6.7%),portal hypertensive gastropathy(48.9%vs 12.2%),ascites rate(77.8%vs 44.4%),peritonitis(55.6%vs 22.2%),hepatic encephalopathy(17.8%vs 3.3%)and hepatorenal syndrome(17.8%vs 2.2%)of patients in bleeding group were significantly higher than those in
作者
李雅
唐奇远
赖长祥
黄嘉敏
伍婷
何清
Li Ya;Tang Qiyuan;Lai Changxiang;Huang Jiaming;Wu Ting;He Qing(Department of Hepatology,The Third People’s Hospital of Shenzhen,Affiliated to Guangdong Medical University,Shenzhen 518112,Guangdong Province,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2021年第3期56-61,共6页
Chinese Journal of Liver Diseases：Electronic Version
基金
广东省医学科学技术研究基金“慢性乙肝患者免疫状态评分及其在干扰素治疗过程中的预警研究”项目(A2019570)。
关键词
乙型肝炎病毒相关肝细胞癌
上消化道出血
影响因素
Hepatitis B virus-related hepatocellular carcinoma
Upper gastrointestinal bleeding
Influencing factors
