摘要
目的 分析基于4项因素的肝纤维化指数(FIB-4)值动态变化对恩替卡韦治疗的慢性乙型肝炎肝硬化病人患肝癌风险的预测价值。方法 对2016年8月至2019年8月于惠州市第三人民医院感染内科收治的慢性乙型肝炎肝硬化病人189例进行研究。所有病人给予恩替卡韦治疗,随访2年后根据病人是否患肝癌分为肝癌组和对照组。比较两组的一般资料,实验室指标和FIB-4等项目。采用多因素logistic回归分析影响慢性乙型肝炎肝硬化病人患肝癌风险的相关因素,应用受试者操作特征(ROC)曲线分析FIB-4等因素预测慢性乙型肝炎肝硬化患肝癌风险的价值。结果 纳入研究的病人中有17例病例脱落,剩余病例中有41例出现肝癌,肝癌发生率为23.83%。两组性别、血压、葡萄糖等临床资料对比差异无统计学意义(P>0.05)。但肝癌组肝硬化病程(3.15±1.05)年大于对照组(2.21±0.76)年(P<0.05);肝癌组乙肝DNA定量阳性率46.34%(19/41)高于对照组25.95%(34/131)(P<0.05)。两组入组时FIB对比差异无统计学意义(P>0.05),肝癌组入组6个月后FIB-4(3.92±1.06)、入组12个月FIB-4(4.03±1.11)、1~6月FIB-4值变化差值(0.49±0.11)、1~12月FIB-4值变化差值(0.64±0.19)、1~6月FIB-4值变化比(15.78±3.17)%、1~12月FIB-4值变化比(18.88±3.21)%均大于对照组3.40±0.96、3.54±1.03、0.36±0.08、0.46±0.14、(10.41±2.63)%、(14.94±3.34)%(均P<0.05);肝癌组6~12月FIB-4值变化差值(0.11±0.03)和6~12月FIB-4值变化比(2.81±0.87)均小于对照组(0.14±0.04、3.53±1.12)(均P<0.05)。两组入组时和入组6个月的肝脏弹性测定值(FibroScan值)对比差异无统计学意义(P>0.05);肝癌组入组12个月FibroScan值(9.34±1.52)高于对照组(8.76±1.16)(P<0.05)。多因素logistic回归分析显示:肝硬化病程[OR=4.31,95%CI:(1.34,13.82)]、乙肝DNA定量[OR=7.19,95%CI:(1.15,44.88)]和1~6月FIB-4值变化比[OR=1.92,95%CI:(1.37,2.70)]是慢性乙型肝炎肝硬化病人发展为肝癌风险
Objective To analyze the predictive value of dynamic changes of fibrosis index based on the 4 factors(FIB-4)on the risk of liver cancer in patients with chronic hepatitis B cirrhosis treated with entecavir.Methods A total of 189 patients with chronic hepatitis B cirrhosis admitted to the Department of Infectious Diseases of the Third People's Hospital of Huizhou from August 2016 to August 2019 were studied.All patients were treated with entecavir and were divided into liver cancer group and control group according to whether they developed liver cancer after 2 years of follow-up.General information,laboratory indicators and FIB-4 items were compared between the two groups.Multivariate Logistic regression was used to analyze the relevant factors affecting the risk of liver cancer in patients with chronic hepatitis B cirrhosis,and ROC curve was used to analyze the value of FIB-4 and other factors in predicting the risk of liver cancer in patients with chronic hepatitis B cirrhosis.Results Among the patients included in the study,17 cases fell off,and 41 of the remaining cases had liver cancer.The incidence of liver cancer was 23.83%.There was no significant difference in gender,blood pressure,glucose and other clinical data between the two groups(P>0.05).Howere,the duration of cirrhosis in HCC group(3.15±1.05)years was longer than that in control group(2.21±0.76)years(P<0.05).The positive rate of HBV DNA in HCC group 46.34%(19/41)was higher than that in control group 25.95%(34/131)(P<0.05).There was no significant difference in FIB between the two groups at enrollment(P>0.05).The FIB-4 value in liver cancer group was(3.92±1.06)after 6 months,(4.03±1.11)after 12 months,(0.49±0.11)from January to June,(0.64±0.19)from January to December,the change ratio of FIB-4 value from January to June(15.78±3.17)%,the change ratio of FIB-4 value from January to December(18.88±3.21)%were higher than the control group 3.40±0.96,3.54±1.03,0.36±0.08,0.46±0.14,(10.41±2.63)%,(14.94±3.34)%(all P<0.05).The difference(0.11±
作者
梁紫茵
周伟泽
黄秀明
邓振雄
利旭辉
LIANG Ziyin;ZHOU Weize;HUANG Xiuming;DENG Zhenxiong;LI Xuhui(Department of Infectious Diseases,Huizhou Third People's Hospital(Guangzhou Medical University Affiliated Huizhou Hospital),Huizhou,Guangdong 516000,China)
出处
《安徽医药》
CAS
2023年第6期1211-1216,共6页
Anhui Medical and Pharmaceutical Journal
