乙肝肝硬化并发原发性肝癌危险因素的logistic回归分析

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摘要【目的】探讨乙肝肝硬化（hepatitic cirrhosis， HC）并发原发性肝细胞癌（Hepatocellular carcinoma，HCC）的危险因素。【方法】选取2011年5月至2016年5月本院收治的133例HC并发HCC患者作为观察组，选取同期本院收治的HC未并发HCC患者133例作为对照组（HC病程≥10年）。收集整理两组患者的临床资料，采用多因素Logistic回归分析筛选HC并发HCC的危险因素。【结果】单因素分析结果显示：观察组患者在肝癌家族史（一级亲属）、饮酒史、吸烟史、酒精性脂肪肝、非酒精性脂肪肝、糖尿病史、HBeAg阳性、HBVDNA>104 copies/mL及未抗病毒治疗等方面的构成比明显高于对照组，差异具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，HC并发HCC的独立危险因素有：肝癌家族史（一级亲属）（OR=4.173,95%CI 1.673～9.602，P=0.000）；饮酒指数3～7（OR=3.282, 95%CI 1.265～5.273，P=0.001）；饮酒指数8～16（OR=4.732，95%CI 1.644～8.574，P=0.000）；吸烟指数8～16（OR=4.121, 95%CI 1.543～5.288，P=0.000）；酒精性脂肪肝（OR=4.763, 95%CI 1.442～7.219，P=0.000）；糖尿病史（OR=3.982, 95%CI 1.743～6.182，P=0.000）；HBeAg阳性（OR=3.172,95%CI 1.543～5.182，P=0.001）；HBVDNA（104～105 copies/mL）（OR=5.874,95%CI 2.382～9.104，P=0.000）；HBVDNA（105～106 copies/mL）（OR=7.473, 95%CI 2.874～12.129，P=0.000）；HBVDNA（106～107 copies/mL）（OR=10.393,95%CI 6.182～34.645，P=0.000）；HBVDNA（≥107 copies/mL）（OR=12.475, 95%CI 6.987～39.543，P=0.000）；未抗病毒治疗（OR=6.122,95%CI 2.884～8.138，P=0.000）。【结论】HBeAg阳性、HBVDNA>104 copies/mL、未抗病毒治疗、有长期吸烟饮酒史、糖尿病史、肝癌家族史（一级亲属）的HC患者发生HCC的危险性较高。

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	占春玲

关键词 ：肝炎, 乙型/并发症, 肝硬化/病因学, 肝硬化/并发症, 肝肿瘤/病因学, Logistic模型, 危险因素

Abstract：

【Objective】 To investigate the risk factors of the hepatitis cirrhosis（HC）complicated with hepatocellular carcinoma (HCC).【Methods】 One hundred and thirtythree cases of HC complicated HCC patients admitted in our hospital were selected from May 2011 to May 2016 as the observation group, and another 133 cases of HC noncomplicated HCC patients (HC course more than 10 years) as the control group. The clinical data of two groups were collected and sorted; the risk factors of HC complicated with HCC were screened by multi factor Logistic regression analysis.【Results】 Single factor analysis showed that the proportion of patients in the observation group was significantly higher than that in the control group in the fields of family history of liver cancer (first degree relatives), drinking history, smoking history, alcoholic fatty liver, nonalcoholic fatty liver, diabetes history, HBVDNA>104 copies/mL and not anti viral treatment, the difference was statistically significant (P<0.05).The independent risk factors of HC complicated with HCC were: family history of liver cancer (firstdegree relatives) （OR=4.173,95%CI 1.673～9.602，P=0.000） ; alcohol drinking index 3～7（OR=3.282, 95%CI 1.265～5.273，P=0.001）; alcohol drinking index 8～16（OR=4.732，95%CI 1.644～8.574，P=0.000） ; smoking index 8～16（OR=4.121, 95%CI 1.543～5.288，P=0.000）; alcoholic fatty liver（OR=4.763, 95%CI 1.442～7.219，P=0.000）; diabetes mellitus（OR=3.982, 95%CI 1.743～6.182，P=0.000）; HBeAg positive（OR=3.172,95%CI 1.543～5.182，P=0.001）；HBVDNA（104～105 copies/mL）（OR=5.874,95%CI 2.382～9.104，P=0.000）；HBVDNA（105～106 copies/mL）（OR=7.473, 95%CI 2.874～12.129，P=0.000）；HBVDNA（106～107 copies/mL）（OR=10.393,95%CI 6.182～34.645，P=0.000）；HBVDNA（≥107 copies/ml）（OR=12.475, 95%CI 6.987～39.543，P=0.000）; no anti viral treatment（OR=6.122,95%CI 2.884～8.138，P=0.000）.【Conclusion】HBeAg positive, HBVDNA>104 copies/ml, nonantiviral treatment, a long history of drinking, smoking, diabetes history, family history of liver cancer (firstdegree relatives) are the high risk factors of HC complicated with HCC.

Key words： Hepatitis B/CO Liver Cirrhosis/ET Liver Cirrhosis/CO Liver Neoplasms/ET Logistic Models Risk Factors

收稿日期: 2016-06-06

引用本文:

占春玲. 乙肝肝硬化并发原发性肝癌危险因素的logistic回归分析[J]. 医学临床研究, 2016, 33(9): 1697-1701.
ZHAN Chunling. Logistic Regression Analysis of Risk Factors of Hepatitis Cirrhosis（HC）Complicated With Hepatocellular Carcinoma (HCC). JOURNAL OF CLINICAL RESEARCH, 2016, 33(9): 1697-1701.

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http://www.jcr.net.cn/CN/ 或 http://www.jcr.net.cn/CN/Y2016/V33/I9/1697