HBV相关肝细胞癌根治性肝切除术患者术后微血管侵犯的危险因素分析

摘要/Abstract

摘要： 目的探讨乙型肝炎病毒(HBV)相关肝细胞癌(HCC)根治性肝切除术后微血管侵犯(MVI)的危险因素。方法选取2020年1月至2024年6月东部战区总医院收治的120例HBV相关HCC患者,所有患者均行根治性肝切除术,术后发生MVI 30例,未发生MVI 90例。比较两组一般资料,TBil、DBil、ALT、AST、糖类抗原19-9(CA19-9)、AFP、中性粒细胞与淋巴细胞比值(NLR)、CA19-9/γ-谷氨酰转肽酶(GGT)比值水平;多因素logistic逐步回归分析HBV相关HCC根治性肝切除术后发生MVI的危险因素。结果未发生MVI组病理低分化占33.33%、肿瘤最大直径＞5 cm占47.78%、包膜强化占48.89%、NLR为1.75±0.56、CA19-9/GGT为2.41±0.47、AFP>400 μg/L占40.00%,发生MVI组分别为66.67%、73.33%、70.00%,NLR为3.21±1.02、CA19-9/GGT为3.03±0.56,差异均有统计学意义(P<0.05)。病理低分化(OR:2.685,95%CI:1.124～6.414)、肿瘤最大直径＞5 cm(OR:2.756,95%CI:1.231～6.170)、包膜强化(OR:2.674,95%CI:1.198～5.969)、NLR(OR:2.168,95%CI:1.321～3.558)、CA19-9/GGT(OR:1.639,95%CI:1.210～2.220)、AFP>400 μg/L(OR:2.895,95%CI:1.358～6.172)是HBV相关HCC根治性肝切除术后发生MVI的危险因素。结论 HBV相关HCC患者根治性肝切除术后发生MVI与病理低分化、肿瘤最大直径＞5 cm、包膜强化、NLR、CA19-9/GGT、AFP>400 μg/L联系密切,临床应密切监测。

关键词: 乙型肝炎病毒, 肝细胞癌, 根治性肝切除术, 微血管侵犯, 危险因素

Abstract: Objective To explore the risk factors of microvascular invasion (MVI) after radical hepatectomy for hepatitis B virus (HBV)-related hepatocellular carcinoma. Methods One hundred and twenty patients with hepatitis B-related liver cancer in General Hospital of Eastern Theater Command from January 2020 to June 2024 were retrospectively selected. All patients underwent operation of radical hepatectomy. According to the postoperative pathological results, they were divided into a MVI group (n=30) and a non-MVI group (n=90). The general data of both groups of patients were compared and the levels of total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), carbohydrate antigen 19-9 (CA19-9), alpha fetoprotein (AFP), neutrophil to lymphocyte ratio (NLR), and carcinoembryonic antigen 19-9 (CA19-9)/gamma glutamyl transpeptidase (GGT) ratio of all patients were measured; The risk factors of MVI after radical hepatectomy for hepatitis B-related liver cancer were identified through multiple factors and unconditional logistic stepwise regression analysis. Results The proportion of pathological low differentiation (66.67%), tumor maximum diameter>5 cm (73.33%), capsule enhancement (70.00%), AFP>400 μg/L (60.00%), NLR level (3.21 ± 1.02), CA19-9/GGT level (3.03 ± 0.56) in the MVI group were higher than those of the proportion of pathological low differentiation (33.33%), tumor maximum diameter>5 cm (47.78%), capsule enhancement (48.89%), NLR level (1.75 ± 0.56), CA19-9/GGT level (2.41 ± 0.47), AFP>400 μg/L (40.00%)} in the non-MVI group (P<0.05); Pathological poor differentiation (OR=2.685, 95%CI:1.124～6.414), maximum tumor diameter>5 cm (OR= 2.756, 95% CI:1.231～6.170), capsule enhancement (OR=2.674, 95% CI:1.198～5.969), NLR (OR=2.168, 95%CI:1.321～3.558), CA19-9/GGT (OR: 1.639, 95% CI: 1.210～2.220), AFP>400 μg/L (OR: 2.895,95% CI: 1.358～6.172) are the risk factors of patients with MVI after radical hepatectomy for hepatitis B-related liver cancer (all P<0.05). Conclusion The occurrence of MVI in patients with hepatitis B-related liver cancer after radical hepatectomy is closely related to poor pathological differentiation, tumor maximum diameter>5 cm, capsule enhancement, NLR, CA19-9/GGT ratio, AFP>400 μg/L, and thus these should be closely monitored in clinical practice.

Key words: Hepatitis B virus, Hepatocellular carcinoma, Radical liver resection, Microvascular invasion, Risk factors

叶青, 毛宇锋. HBV相关肝细胞癌根治性肝切除术患者术后微血管侵犯的危险因素分析[J]. 肝脏, 2026, 31(8): 1107-1111.

Ye Qing, Mao Yufeng. The risk factors of microvascular invasion after radical hepatectomy for hepatitis B-related liver cancer[J]. Chinese Hepatolgy, 2026, 31(8): 1107-1111.

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