| 原发性胆汁性胆管炎患者发生肝癌的危险因素研究 |
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| 引用本文： | 井小笛,姚建宁,李艳乐,王春峰,张连峰.原发性胆汁性胆管炎患者发生肝癌的危险因素研究[J].中国肿瘤临床,2019,46(16):836-840. |
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| 作者姓名： | 井小笛 姚建宁 李艳乐 王春峰 张连峰 |
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| 作者单位： | 郑州大学第一附属医院消化内科(郑州市 450052) |
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| 摘 要： | 目的 探讨原发性胆汁性胆管炎（primary biliary cholangitis，PBC）患者发生肝癌的危险因素。 方法 回顾性分析2011年1月至2016年12月郑州大学第一附属医院670例PBC患者的病例资料，随访确定发生肝癌的患者，应用病例对照研究的方法探索PBC患者发生肝癌的潜在危险因素，使用Logistic回归模型进行单因素和多因素分析，计算相关因素的危险比及95%置信区间（confidence interval，CI）。 结果 通过随访，确定发生肝癌的PBC患者35例（5.2%），其中4例（女性4例）因相关影响因素不全不可纳入病例对照研究，另有6例（男性2例，女性4例）因与PBC同时或先于诊断而不能纳入研究，因此本研究纳入病例对照研究的患者共25例。男性PBC相关性肝癌患者较女性易伴有饮酒史、吸烟史、输血史和家族性恶性肿瘤史（P < 0.05），且肝功能损害更为严重，表现为ALT、AST和GGT的水平均高于女性患者（P < 0.05）。Logistic回归模型分析显示体质量指数（body mass index，BMI）≥ 25和饮酒史与PBC患者发生肝癌风险增加呈独立相关（均P < 0.05）。 结论 研究显示BMI ≥ 25和饮酒史为PBC相关性肝癌发生的独立危险因素。因此，PBC患者除常规筛查外，可从戒酒和控制体质量中受益。
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| 关 键 词： | 原发性胆汁性胆管炎 肝癌 危险因素 熊去氧胆酸 |
| 收稿时间： | 2019-06-30 |
Risk factors for hepatocellular cancer occurrence in patients with primary biliary cholangitis |
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| Affiliation: | Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China |
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| Abstract: | To investigate the potential risk factors for hepatocellular carcinoma in primary biliary cholangitis (PBC) patients. Methods The data of 670 PBC inpatients between January 2011 and December 2016 were collected from the database of The First Affiliated Hospital of Zhengzhou University. The potential risk factors were evaluated, and odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed by univariate (unadjusted OR) and multivariateadjusted OR (AOR)] conditional Logistic regression. Results In total, 35 PBC patients developed liver carcinoma (5.2%); of these, 4 patients (female) were excluded because of incomplete data for influencing factors and 6 (2 male; 4 female) were excluded as they were diagnosed with hepatocellular carcinoma (HCC) during or before PBC. Therefore, 25 patients were included in the case-control study. Male patients were more likely than female patients to show alcohol intake, smoking, a family history of malignancy, and serious liver injury (all P < 0.05), indicated by the increasing levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transferase (GGT)(P < 0.05). Conditional Logistic regression analysis revealed that body mass index (BMI) ≥ 25 kg/m2 (AOR=1.015, 95% CI:1.001-1.257, P=0.032) and history of alcohol intake (AOR=10.014, 95% CI:1.009-91.071, P=0.039) were significantly associated with increased odds of HCC development in PBC patients. Conclusions The risk factors for PBC-associated liver carcinoma include BMI ≥ 25 kg/m2 and history of alcohol intake. In addition to regular monitoring, PBC patients may benefit from alcohol abstinence and body weight control. |
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