摘要目的 观察乙型肝炎肝硬化患者经核苷(酸)类药物治疗期间新发肝癌的情况,并分析其发病的危险因素.方法 采集中山大学附属第三医院2008年4月-2011年6月门诊随访的用核苷(酸)类药物抗病毒治疗的141例乙型肝炎肝硬化患者的病历资料,回顾性调查其人口学资料及临床指标,包括病毒学和生化学应答等,并采用单因素分析及多因素Cox回归分析评估治疗期间新发肝癌的危险因素.结果 随访32.5个月(6.4 ～87.6个月),141例乙型肝炎肝硬化患者中,发生肝癌15例,肝癌的年平均发病率为3.8％.统计学分析显示,基线HBeAg阳性和有肝癌家族史者核苷(酸)类药物抗病毒治疗期间新发肝癌的风险显著升高(RR=4.524和3.858,P＜0.05),是新发肝癌的独立危险因素.结论 乙型肝炎肝硬化患者口服核苷(酸)类药物抗病毒治疗仍有发生肝癌的风险,基线HBeAg阳性和有肝癌家族史的患者发生肝癌的风险较高.

abstractsObjective To survey the incidence of hepatocellular carcinoma (HCC) in patients with HBV-related cirrhosis receiving nucleos(t)ide analogues treatment and to assess its risk factors.Methods A total of 141 patients with HBV-related liver cirrhosis receiving nucleos(t) ide therapy from April 2008 to June 2011 were enrolled.The clinical data including virological and biochemical tests were retrospectively analyzed.Univariate and multivariate Cox proportional hazards regression model was used to identify the risk factors of HCC occurrence.Results Patients were followed up for 6.4 to 87.6 months with a median followup time of 32.5 months.During the follow-up period,15 out of 141 patients developed HCC with an average annual incidence rate of 3.8％.HCC incidence was higher in HBeAg positive cirrhosis and in those with family history of liver cancer ( RR =4.524 and 3.858,P ＜ 0.05 ).Conclusions Patients with HBV-related cirrhosis have a high incidence rate of HCC even they recieve nucleos (t) ide analogues treatment.HBeAg positive cirrhosis and family history of liver cancer are independent risk factors for HCC.