摘要目的 分析影响HBV相关肝癌(HBV-PLC)转归的危险因素,总结抗病毒治疗对原发性肝癌(PLC)的影响.方法 回顾性分析1999年和2009年首都医科大学附属北京佑安医院收治的HBV-PLC患者的病历资料,PLC的影响因素,以及抗病毒治疗对HBV-PLC发展和转归的影响.正态分布的计量资料比较采用t检验,非正态分布的计量资料比较采用秩和检验,计数资料比较采用卡方检验.结果 2009年HBV-PLC在各种原因所致PLC中所占比例较1999年明显下降(89.81％比70.72％,x2=18.153,P=0.000).2009年HBV-PLC患者首诊年龄较1999年后移[(51.2±9.3)岁比(53.5±9.9)岁,t=-2.268,P=0.024)],病死率降低(6.94％比31.96％,x2=65.949,P=0.000),生存时间延长(150.0 d比13.5d,Z=-10.353,P=0.000).2009年HBV-PLC中抗病毒者占35.30％(341/966),疗程1年以上的仅占30.21％(103/341).抗病毒治疗显著降低PLC患者腹水发生率(54.25％比61.92％,x2=5.371,P=0.020)和腹腔感染发生率(31.67％比44.96％,x2=16.197,P=0.000).抗病毒治疗可以显著延长患者生存时间(212 d比121 d,Z=-4.601,P=0.000),且转阴组(HBV DNA＜500拷贝/mL)病死率显著降低(4.46％比12.80％,x2=6.464,P=0.011).多因素Logistic回归分析显示,男性(OR=1.753,P=0.038)、未抗病毒治疗(OR=1.734,P=0.042)及HBV DNA阳性(OR=0.624,P=0.006)是影响HBV-PLC转归的独立危险因素.结论 男性、未抗病毒治疗和HBV DNA阳性是PLC预后不良的独立危险因素;抗病毒治疗可减少PLC患者腹水和腹腔感染的发生率,并延长生存时间.

abstractsObjective To analyze the risk factors associated with the prognosis of hepatitis B virus (HBV)-related primary liver carcinoma (PLC),and to conclude the effect of antiviral therapy on HBV-related PLC.Methods Patients with HBV-related PLC hospitalized at Beijing Youan Hospital Affilicated to Capital Medical University from 1999 to 2009 were retrospectively enrolled.Factors associated with HBV-related PLC and the effect of antiviral therapy on the progression and outcome of HBV-related PLC were analyzed.Normally distributed measurement data were analyzed by t test,rank sum was performed for non-normal distributed measurement data,the categorical data analysis used chi-square test.Results The proportion of HBV related PLC in PLC caused by various reasons decreased significantly in 2009 compared to that in 1999 (70.72％ vs 89.81％,x2=18.153,P=0.000).Age at first visited was postponed than 10 years ago ([51.2±9.3] vs [53.5±9.9] years; t=-2.268,P=0.024),the mortality was reduced (31.96％ vs 6.94％; x2 =65.949,P=0.000),and the survival duration was prolonged (13.5 d vs 150.0 d; Z =-10.353,P =0.000).The proportion of HBV-related PLC patients who received antiviral therapy was only 35.30％ in 2009.Among them,only 30.21％ of the patients received antiviral treatment for more than one year.The incidence of ascites (54.25％ vs 61.92％ ; x2 =5.371,P=0.020) and abdominal infection (31.67％ vs 44.96％; x2 =16.197,P=0.000) decreased significantly in patients with HBV-related PLC receiving antiviral therapy.The median survival duration in antiviral group was significantly prolonged than that in non-antiviral group (212 d vs 121 d; Z=-4.601,P=0.000).The mortality rate decreased significantly in patients achieving undetectable HBV DNA (4.46％ vs 12.80％; x2 =6.464,P=0.011).Multivariate regression analysis showed that male (OR =1.753,P=0.038),treatment-naive (OR=1.734,P=0.042) and HBV DNA positivity (OR=0.624,P=0.006) were the independent risk factors associated with the prognosis of HBV-related PLC.Conclusions Male,treatment-naive and HBV DNA positivity are independent risk factors associated with the prognosis of HBV-related PLC.Antiviral therapy may reduce the incidence rates of ascites and abdominal infection and prolong the survival duration in patients with HBV-related PLC.