内脏脂肪组织指数变化对非肝硬化病毒性肝炎肝细胞癌患者的影响

摘要/Abstract

摘要： 目的分析乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染的非肝硬化患者发生肝细胞癌(HCC)的危险因素。方法搜集2019年1月—2022年6月期间徐州医科大学附属医院收治的HBV/HCV感染HCC病例共计212例,其中男性143例、女性69例,年龄(65.0±11.8)岁。HCC诊断符合要求。参考既往文献,当FIB-4指数>3.25时,慢性肝病患者可诊断存在肝硬化,据此将纳入病例分为非肝硬化组、肝硬化组。比较HBV-HCC、HCV-HCC以及非肝硬化、肝硬化组临床资料,采用多因素logistic回归分析探讨HBV或HCV感染的非肝硬化患者发生HCC的影响因素。结果 HBV-HCC患者年龄、糖尿病、高血压、Child-Pugh评分及FIB-4指数分别为(61.2±11.8)岁、23例(15.9%)、41例(28.3%)、(9.0±1.2)分及(3.4±0.6)分,与HCV-HCC[(70.1±10.7)岁、19例(28.3%)、29例(43.3%)、(5.7±0.9)分及(6.2±1.1)分]相比,差异均有统计学意义(P<0.05),同时HBV-HCC、HCV-HCC患者肿瘤分期差异统计学意义(P<0.05)。非肝硬化、肝硬化HBV-HCC患者内脏脂肪组织指数(VATI)、Child-Pugh评分及HbA1c比较,差异具有统计学意义(P<0.05);同时非肝硬化、肝硬化HCV-HCC患者性别、VATI、Child-Pugh评分及HbA1c比较,差异也具有统计学意义(P<0.05)。多因素logistic回归分析表明年龄、男性、VATI、HbA1c 、高血压以及HBV感染是非肝硬化患者HCC的独立危险因素(P<0.05)。结论较高的VATI、男性、糖尿病、高血压以及HBV感染等是非肝硬化患者发生HCC的危险因素,针对上述因素对非肝硬化患者进行HCC筛查具有临床意义。

关键词: 肝细胞癌, 乙型肝炎病毒, 丙型肝炎病毒, 内脏脂肪组织指数

Abstract: Objective To analyze the risk factors of hepatocellular carcinoma (HCC) in non-cirrhosis patients infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Methods A total of 212 cases of HBV/HCV-infected HCC patients admitted to Xuzhou Medical University Affiliated Hospital were collected from January 2019 to June 2022. The cases included 143 males and 69 females, with an average age of (65.0±11.8) years. The diagnosis of HCC met the requirements. According to the previous literature, when the FIB-4 index was >3.25, patients with chronic liver disease could be diagnosed with cirrhosis. Based on this, the cases were divided into a non-cirrhosis group and a cirrhosis group. The clinical data of HBV-HCC, HCV-HCC, non-cirrhosis and cirrhosis groups were compared, and multivariate logistic regression analysis was used to identify the factors influencing HCC in non-cirrhosis patients infected by HBV or HCV. Results The average age of HBV-HCC patients was 61.2±11.8 years, with 23 cases (15.9%) having diabetes and 41 cases (28.3%) having hypertension. The Child-Pugh score and FIB-4 index for HBV-HCC patients were 9.0±1.2 and 3.4±0.6, respectively. In comparison, HCV-HCC patients had an average age of 70.1±10.7 years, with 19 cases (28.3%) having diabetes and 29 cases (43.3%) having hypertension. The Child-Pugh score and FIB-4 index for HCV-HCC patients were 5.7±0.9 and 6.2±1.1, respectively. These differences were found to be statistically significant (P<0.05). Additionally, there was a statistically significant difference in tumor staging between HBV-HCC and HCV-HCC patients (P<0.05). Among both non-cirrhosis and cirrhosis patients with HBV-HCC, the visceral adipose tissue index (VATI), Child-Pugh score and HbA1c were significantly different (P< 0.05). Similarly, there were significant differences in sex, VATI, Child-Pugh score and HbA1c between non-cirrhosis and cirrhosis patients with HCV-HCC (P<0.05). Multivariate logistic regression analysis showed that age, male, VATI, HbA1c, hypertension and HBV infection were independent risk factors for HCC in non-cirrhosis patients (P<0.05). Conclusion High VATI, male gender, diabetes, hypertension, and HBV infection are risk factors for HCC in non-cirrhosis patients. It is clinically significant to screen for HCC in patients with non-cirrhosis.

Key words: Hepatocellular carcinoma, Hepatitis B virus, Hepatitis C viru, Visceral adipose tissue index

李博闻, 费素娟. 内脏脂肪组织指数变化对非肝硬化病毒性肝炎肝细胞癌患者的影响[J]. 肝脏, 2023, 28(10): 1182-1185.

LI Bo-wen, FEI Su-juan. Effect of visceral adipose tissue index on hepatocellular carcinoma patients with non-cirrhosis viral hepatitis[J]. Chinese Hepatolgy, 2023, 28(10): 1182-1185.

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