Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

AIM： To identify prognostic factors of patients with hepatocellular carcinoma （HCC）, who were treated by orthotopic liver transplantation （OLT）. METHODS： From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. RESULTS： The median follow-up was 13.0 mo （2.8-69.5 too）. Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3- and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria （97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively） compared with that of patients who met the Milan or University of California, San Francisco （UCSF） criteria. CONCLUSION： Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely affect the outcome of liver transplantation for HCC, compared with the Milan or UCSF criteria.     

老年高血压合并2型糖尿病患者餐后血糖与血压关系的研究

目的探讨老年高血压合并2型糖尿病患者,餐后血糖与炎症因子C-反应蛋白、脉压、昼夜血压的关系及临床意义。方法选择单纯高血压、高血压合并2型糖尿病餐后高血糖患者及健康体检者各30例,均测定空腹血糖（FPG）、餐后2h血糖（2hPG）、空腹血浆胰岛素（FINs）、糖化血红蛋白（HbAlC）、血清C-反应蛋白（CRP）,计算胰岛抵抗指数（IRI）,高血压患者行动态血压监测（ABPM）。对各组的CRP、糖代谢指标、动态血压参数等进行统计学分析,并比较高血压合并2型糖尿病餐后高血糖患者治疗前后各项指标。结果高血压合并糖尿病组FPG、2hPG、FINS、IRI、HbAlC及CRP各指标与单纯高血压组及正常对照组比较差异有统计学意义（P〈0．05）,单纯高血压组FINS、IRI及CRP高于正常对照组,差异有统计学意义（P〈0．05）;与单纯高血压患者相比,高血压合并糖尿病餐后高血糖组患者脉压（PP）增大,非杓型比率高,差异有统计学意义（P〈0．05）;高血压合并糖尿病餐后高血糖患者治疗后PP、非杓型比率下降,与治疗前比较差异有统计学意义（P〈0．05）。结论高血压与糖尿病同样存在胰岛素抵抗,高血压合并糖尿病患者,餐后血糖与CRP水平、PP、血压昼夜节律异常相关,餐后血糖的控制可能有助于夜间杓型血压的恢复,延缓动脉粥样硬化的进程。     

二肽基肽酶4抑制剂沙格列汀控制餐后血糖的关键:促进餐后胰岛素分泌

T2DM是常见慢性代谢性疾病,给患者和社会带来沉重负担。控制餐后血糖(PPG),改善Ins分泌在T2DM患者的血糖管理中处于重要地位。二肽基肽酶4抑制剂沙格列汀可有效控制T2DM患者PPG,不良反应少,患者耐受良好。本文对T2DM患者PPG的临床意义、PPG升高机制、沙格列汀控制PPG的优势进行综述,旨在为临床治疗T2DM提供依据。     

原发性肝癌患者不同糖代谢异常状态的临床分析

目的探讨原发性肝癌（HCC）患者在不同糖代谢异常状态下的临床特点。方法回顾性分析2003年1月至2007年12月在汕头大学第一、二附属医院住院的698例HCC患者不同糖代谢状态的临床资料。根据糖代谢状态将患者分为4组：糖代谢正常组（472例）、低血糖组（20例）、糖尿病前期组（76例）和糖尿病组（130例）。用方差分析比较各组年龄差异,Kruskal-WallisH检验分析各组血脂代谢等实验室检查的差异。结果纳入本研究698例HCC患者中男性563例,女性135例,平均年龄（55±13）岁。糖尿病前期及糖尿病组患者年龄均高于糖代谢正常组,差异均有统计学意义[分别为（58±13）、（60±13）和（53±15）岁,均P〈0．05];低血糖症组年龄[（51±14）岁]小于糖尿病组,差异有统计学意义（P〈0．05）。HCC患者糖尿病状态下总胆固醇（TC）水平较糖代谢正常组低,差异有统计学意义[（4．7±1．7）比（4．0±1．7）mmol／L,t=2．266,P〈0．05]。结论HCC合并糖尿病较糖代谢正常组和低血糖症组的年龄大,且HCC合并糖尿病组患者Tc水平较糖代谢正常组低。     

Early extrahepatic recurrence as a pivotal factor for survival after hepatocellular carcinoma resection: A 15-year observational study

BACKGROUNDSurgical resection is one of the most widely used modalities for the treatment of hepatocellular carcinoma (HCC). Early extrahepatic recurrence (EHR) of HCC after surgical resection is considered to be closely associated with poor prognosis. However, data regarding risk factors and survival outcomes of early EHR after surgical resection remain scarce.AIMTo investigate the clinical features and risk factors of early EHR and elucidate its association with survival outcomes.METHODSFrom January 2004 to December 2019, we enrolled treatment-naïve patients who were ≥ 18 years and underwent surgical resection for HCC in two tertiary academic centers. After excluding patients with tumor types other than HCC and/or ineligible data, this retrospective study finally included 779 patients. Surgical resection of HCC was performed according to the physicians’ decisions and the EHR was diagnosed based on contrast-enhanced computed tomography or magnetic resonance imaging, and pathologic confirmation was performed in selected patients. Multivariate Cox regression analysis was performed to identify the variables associated with EHR.RESULTSEarly EHR within 2 years after surgery was diagnosed in 9.5% of patients during a median follow-up period of 4.4 years. The recurrence-free survival period was 5.2 mo, and the median time to EHR was 8.8 mo in patients with early EHR. In 52.7% of patients with early EHR, EHR occurred as the first recurrence of HCC after surgical resection. On multivariate analysis, serum albumin < 4.0 g/dL, serum alkaline phosphatase > 100 U/L, surgical margin involvement, venous and/or lymphatic involvement, satellite nodules, tumor necrosis detected by pathology, tumor size ≥ 7 cm, and macrovascular invasion were determined as risk factors associated with early EHR. After sub-categorizing the patients according to the number of risk factors, the rates of both EHR and survival showed a significant correlation with the risk of early EHR. Furthermore, multivariate analysis revealed that early EHR was associated with substantially worse survival outcomes (Hazard ratio, 6.77; 95% confidence interval, 4.81-9.52; P < 0.001).CONCLUSIONEarly EHR significantly deteriorates the survival of patients with HCC, and our identified risk factors may predict the clinical outcomes and aid in postoperative strategies for improving survival.     

Local recurrence is an important prognostic factor of hepatocellular carcinoma

AIM: To clarify the importance of complete treatment by PEIT. METHODS: A total of 140 previously untreated cases of HCC were enrolled in this study from 1988 to 2002. The inclusion criteria were: a solitary tumor less than 4 cm in diameter or multiple tumors, fewer than four in number and less than 3 cm in diameter, without extrahepatic metastasis or vessel invasion. As general principles for the treatment of HCC, the patients underwent transcatheter arterial chemoembolization (TACE) prior to PEIT. After the initial treatment of the patients, ultrasonography and computed tomography were performed, and measurement of serum levels of afetoprotein (AFP) was determined. When tumor recurrences were detected, PEIT and/or TACE were repeated whenever the hepatic functional reserve of the patient permitted. We then analyzed the variables that could influence prognosis, including tumor size and number, the serum levels of AFP, the parameters of hepatic function (albumin, bilirubin, ALT, hepaplastin test, platelet number, and indocyanine green retention at 15 min [ICG-R15]), combined therapy with TACE, distant recurrence, and local recurrence. RESULTS: Univariate analysis identified the ICG test, serum levels of AFP and albumin, tumor size and number, and local recurrence, but not distant recurrence, as significant prognostic variables. In multivariate analysis using those five parameters, the ICG test, tumor size, tumor number, and local recurrence were identified as significant prognostic factors. In both univariate and multivariate analyses, the relative risk for the ICG test was the highest, followed by local recurrence. CONCLUSION: We found that local recurrence is an independent prognostic factor of HCC, indicating that achieving complete treatment for HCC on first treatment is important for improving the prognosis of patients with HCC.     

Diabetes mellitus and metformin in hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the leading cause of cancer-related death worldwide. Diabetes mellitus, a risk factor for cancer, is also globally endemic. The clinical link between these two diseases has been the subject of investigation for a century, and diabetes mellitus has been established as a risk factor for HCC. Accordingly, metformin, a first-line oral anti-diabetic, was first proposed as a candidate anti-cancer agent in 2005 in a cohort study in Scotland. Several subsequent large cohort studies and randomized controlled trials have not demonstrated significant efficacy for metformin in suppressing HCC incidence and mortality in diabetic patients; however, two recent randomized controlled trials have reported positive data for the tumor-preventive potential of metformin in non-diabetic subjects. The search for biological links between cancer and diabetes has revealed intracellular pathways that are shared by cancer and diabetes. The signal transduction mechanisms by which metformin suppresses carcinogenesis in cell lines or xenograft tissues and improves chemoresistance in cancer stem cells have also been elucidated. This review addresses the clinical and biological links between HCC and diabetes mellitus and the anti-cancer activity of metformin in clinical studies and basic experiments.     

Construction and clinical significance of a predictive system for prognosis of hepatocellular carcinoma

AIM: The aims of this study were to explore individualized treatment method for hepatocellular carcinoma (HCC) patients whose maximum tumor size was less than 5 cm to improve prognosis and survival quality. METHODS: Thirty cases of primary HCC patients undergoing tumor resection were retrospectively analyzed (resection group). All the tumors were proved as primary HCC with pathologic examination. The patients were divided into two groups according to follow-up results: group A, with tumor recurrence within 1 year after resection; group B, without tumor recurrence within 1 year. Immunohist-ochemical stainings were performed using 11 kinds of monoclonal antibodies (AFP, c-erbB2, c-met, c-myc, HBsAg, HCV, Ki-67, MMP-2, nm23-H1, P53, and VEGF), and expressing intensities were quantitatively analyzed. Regression equation using factors affecting prognosis of HCC was constructed with binary logistic method. HCC patients undergoing percutaneous microwave coagulation therapy (PMCT) were also retrospectively analyzed (PMCT group). Immunohistochemical stainings of tumor biopsy samples were performed with molecules related to HCC prognosis, staining intensities were quantitatively analyzed, coincidence rate of prediction was calculated. RESULTS: In resection group, the expressing intensities of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 2.97, P= 0.01; t = 2.42, P= 0.03<0.05; t = 2.57, P= 0.02<0.05; t = 3.43, P = 0.004<0.01, respectively); the expressing intensities of 11 kinds of detected molecules in para-cancer tissue in groups A and B were not significantly different (P>0.05). The regression equation predicting prognosis of HCC is as follows: P(1) = 1/[1+e-(3.663-0.412mycc-2.187kl-67c-0.397vegfc)]. It demonstrates that prognosis of HCC in resection group was related with c-myc, Ki-67 and VEGF expressing intensity in cancer tissue. In PMCT group, the expressing intensities of c-myc, Ki-67 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 4.57, P= 0.000<0.01; t = 2.08, P= 0.04<0.05; t = 2.38, P= 0.02<0.05, respectively); the expressing intensities of c-myc, Ki-67 and VEGF in para-cancer tissue in groups A and B were not significantly different (P>0.05). The coincidence rate of patients undergoing PMCT in group A was 88.00% (22/25), in group B 68.75% (11/16), the total coincidence rate was 80.49% (33/41). CONCLUSION: The regression equation is accurate and feasible and could be used for predicting prognosis of HCC, it helps to select treatment method (resection or PMCT) for HCC patients to realize individualized treatment to improve prognosis.     

Current biomarkers for hepatocellular carcinoma: Surveillance,diagnosis and prediction of prognosis

Biomarkers for surveillance, diagnosis and prediction of prognosis in patients with hepatocellular carcinoma(HCC) are currently not ready for introduction into clinical practice because of limited sensitivity and specificity. Especially for the early detection of small HCC novel biomarkers are needed to improve the current effectiveness of screening performed byultrasound. The use of high-throughput technologies in hepatocellular research allows to identify molecules involved in the complex pathways in hepatocarcinogenesis. Several invasive and non-invasive biomarkers have been identified already and have been evaluated in different clinical settings. Gene signatures with prognostic potential have been identified by gene expression profiling from tumor tissue. However, a single "all-in-one" biomarker that fits all-surveillance, diagnosis, prediction of prognosis-has not been found so far. The future of biomarkers most probably lies in a combination of non-invasive biomarkers, imaging and clinical parameters in a surveillance setting. Molecular profiling of tumorous and non-tumorous liver tissue may allow a prediction of prognosis for the individual patient and hopefully clear the way for individual treatment approaches. This article gives an overview on current developments in biomarker research in HCC with a focus on currently available and novel biomarkers, in particular on micro RNA.     

肾移植术后空腹血糖变化规律及其对预后的影响分析

目的 探讨肾移植术后存活1年以上患者空腹血糖变化规律及其对预后的影响.方法 收集446例1993年1月至2008年12月接受肾移植手术且移植肾存活1年以上患者的临床资料,根据术前空腹血糖,将患者分为移植前糖尿病、空腹血糖受损、空腹血糖正常3组,观察各组术后空腹血糖变化规律.对428例术前非糖尿病患者,根据空腹血糖分析术后移植后糖尿病( PTDM)发生及转归,比较持续性PTDM和一过性PTDM临床特点,并比较PTDM组和非PTDM组术后并发症及生存率的差异.结果 肾移植后患者血糖整体呈先升高后下降的趋势.428例术前非糖尿病患者,共有87例(20.3％)发生PTDM,其中15例(占总PTDM的17.2％)在随访中转为空腹血糖正常或空腹血糖受损.与持续性PTDM相比,一过性PTDM患者急性排斥反应发生率更高(P=0.043).与非PTDM组相比,PTDM组术后感染、高血压和脂代谢紊乱发生率更高(P＜0.05).平均随访(5.65±3.68)年,两组患者生存率和生存时间未见明显差异.结论 PTDM并非持续存在,在病程中有可能转为空腹血糖受损或空腹血糖正常.急性排斥反应是一过性血糖升高的危险因素.肾移植后PTDM患者术后更容易发生感染、高血压、高血脂等并发症,但本组术后随访,存活率未受明显影响.     

CpG island methylator phenotype in plasma is associated with hepatocellular carcinoma prognosis

AIM:To evaluate the clinical significance of CpG island methylator phenotype(CIMP) in plasma and its asso-ciation with hepatocellular carcinoma(HCC) progress.METHODS:CIMP status of 108 HCC patients wasanalyzed using a methylation marker panel in tumortissues and plasma with methylation-specific poly-merase chain reaction. Fifteen samples of non-neo-plastic liver tissues and 60 of plasma from healthy persons were examined simultaneously. Examinedgenes included APC,WIF-1,RUNX-3,DLC-1,SFRP-1,DKK and E-cad .RES...     

餐后1小时血糖升高的意义及干预

餐后1小时血糖（1hPG）升高的正常糖耐量人群有胰岛β细胞功能损害和早期时相胰岛素分泌减少，其糖尿病和心血管疾病的发病率增加。若利用1hPG进行糖尿病的筛查和一级预防，可以减少糖尿病的发生，提高生活质量，减轻社会负担。     

Microvessel density of hepatocellular carcinoma: its relationship with prognosis

Purpose: To elucidate the relationship between angiogenesis and prognosis after curative resection of hepatocellular carcinoma (HCC). Methods: An immunohistochemical study using anti-CD34 monoclonal antibody was carried out on surgical specimens from 78 HCC patients who had undergone curative resection; microvessel density (MVD) was counted and the overall survival and disease-free survival were analyzed retrospectively. Results: Blood vessels in the tumor were strongly stained by anti-CD34 antibody, but not those in the surrounding liver parenchyma. There were three types of tumor vessels: capillary-like (n = 59), sinusoid-like (n = 16) and mixed-type (n = 3). The median MVD count was 100 per field. The HCC were designated as hypovascular (n = 36) with an MVD count below 100, and hypervascular (n = 42) with an MVD count of 100 or more per field. The 5-year survival and disease-free survival rates were 49.7% and 42.8% respectively, and statistical analysis showed that the MVD level was not correlated with tumor size, capsule status, Edmondson's grade, α-fetoprotein level, associated cirrhosis, γ-glutamyltransferase, and serum HBsAg status. The sinusoid-like tumor vessels appeared more frequently in the more differentiated tumors (P < 0.05). No statistical difference in overall and disease-free survival between different MVD levels and microvessel types was found. Tumor size was the only predicting factor in the entire series. In patients with small HCC (≤ 5 cm, n = 40), 5-year survival and disease-free survival rates were 58.9% and 52.7% respectively, higher than the values in large HCC (39.8% and 32.0% respectively, P < 0.05). The MVD level was an independent predicting factor of disease-free survival, 5-year disease-free survival in the hypovascular group (74.6%) being better than that in the hypervascular group (34.7%, P < 0.05). Conclusions: The MVD level was not related to tumor size, capsule statuo, Edmondson's grade, α-fetoprotein level, associated cirrhosis, γ-glutamyltransferase and serum HBsAg status. In the entire series, tumor size was the only factor influencing survival after curative resection. However, in patients with small HCC, the MVD level was an independent factor of disease-free survival. The pathological and clinical implications of different types of tumor vessels in HCC remain to be studied. Received: 27 November 1998 / Accepted: 5 January 1999     

Importance of SALL4 in the development and prognosis of hepatocellular carcinoma

AIM: To detect the expression of sal-like protein 4(SALL4) and to explore its relationship with clinicopathological characteristics and prognosis of hepatocellular carcinoma(HCC).METHODS: One hundred and twenty-six samples of HCC tissue, 44 of adjacent noncancerous cirrhotic tissue and 10 of liver hemangioma tissue, were obtained from patients who underwent hepatectomy for HCC at the Fourth Hospital of Hebei Medical University. None of the patients had received any form of treatment before the operation. After resection, all the tissues were fixed in 10% neutral formaldehyde and embedded in paraffin. Expression of SALL4 was detected by immunohistochemistry. Patients were followed up for postoperative survival until February 2014. The relationships between SALL4 expression level and clinicopathological data and prognosis of HCC were analyzed. RESULTS: SALL4 expression was negative in the 10 samples of tissue from liver hemangioma, was weakly positive in the two samples from adjacent noncancerous cirrhotic tissue, and positive in 58 samples of HCC tissues. The differences were statistically significant(P 0.05). Expression of SALL4 was higher in patients with higher α-fetoprotein(AFP) levels, portal vein tumor thrombus, and later clinical stage based on the Barcelona Clinic Liver Cancer classification(P 0.05). Among patients with negative expression, weakly positive expression, positive expression, and strongly positive expression of SALL4, the median survival time was 39, 25, 23, and 9 mo, respectively(P 0.001). When both AFP and SALL4 were detected, patients who were negative for both AFP and SALL4, SALL4-positive only, AFP-positive only, and positive for both AFP and SALL4, had a median survival time of 41, 38, 31, and 12 mo, respectively(P 0.001).CONCLUSION: Expression of SALL4 is relevant to the prognosis of HCC patients. Patients with higher expression levels of SALL4 and AFP have worse prognosis.     

Alcohol and hepatocellular carcinoma: A review and a point of view

It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma(HCC)is alcohol consumption.Research in Italy and the United States concludes that the most common cause of HCC(responsible for 32%to 45%of HCC)is alcohol.It has recently been shown that a significant relationship between alcohol intake,metabolic changes,and hepatitis virus infection does exist.Alcohol may be a factor in the development of HCC via direct(genotoxic)and indirect mechanisms(cirrhosis).There is only one way of diagnosing HCC,which is early identification through surveillance,when curative treatments become possible.After stopping alcohol intake the risk of liver cancer decreases by 6%to 7%a year,and an estimated time period of 23 years is also needed.Therefore,surveillance is also important in former drinkers and,in our opinion,independently from the presence of compensated cirrhosis.In cases of very early stage(VES)and early stage with portal hypertension,liver transplantation is the optimal option;and in cases of associated disease,percutaneous ethanol injections,radiofrequency and microwave ablation are the ideal treatments.Despite the possibility of detecting microvascular invasion with HR,several studies and some randomized controlled trials revealed that overall survival and DSF rates in patients with VES HCC are much the same after ablation and HR.Therefore,ablation can be regarded as a firstline choice for patients with VES HCC.It is important to emphasize that the choice of treatment should be weighed carefully in the context of a multidisciplinary cancer team.     

Identification of a five-long non-coding RNA signature to improve the prognosis prediction for patients with hepatocellular carcinoma

AIM To construct a long non-coding RNA(lnc RNA) signature for predicting hepatocellular carcinoma(HCC) prognosis with high efficiency.METHODS Differentially expressed lnc RNAs(DELs) between HCC specimens and peritumor liver specimens were identified using the edge R package to analyze The Cancer Genome Atlas(TCGA) LIHC dataset.Univariate Cox proportional hazards regression was performed to obtain the DELs significantly associated with overall survival(OS) in a training set.These OS-related DELs were further analyzed using a stepwise multivariate Cox regression model.Those lnc RNAs fitted in the multivariate Cox regression model and independently associated with overall survival were chosen to build a prognostic risk formula.The prognostic value ofthis formula was then validated in the test group and the entire cohort and further compared with two previously identified prognostic signatures for HCC.Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed to explore the potential biological functions of the lnc RNAs in the signature.RESULTS Based on lnc RNA expression profiling of 370 HCC patients from the TCGA database,we constructed a 5-lnc RNA signature(AC015908.3,AC091057.3,TMCC1-AS1,DCST1-AS1 and FOXD2-AS1) that was significantly associated with prognosis.HCC patients with high-risk scores based on the expression of the 5 lnc RNAs had significantly shorter survival times compared to patients with low-risk scores in both the training and test groups.Multivariate Cox regression analysis demonstrated that the prognostic value of the 5 lnc RNAs was independent of clinicopathological parameters.A comparison study involving two previously identified prognostic signatures for HCC demonstrated that this 5-lnc RNA signature showed improved prognostic power compared with the other two signatures.Functional enrichment analysis indicated that the 5 lnc RNAs were potentially involved in metabolic processes,fibrinolysis and complement activation.CONCLUSION Our present study constructed a 5-lnc RNA signature that improves survival prediction and can be used as a prognostic biomarker for HCC patients.     

Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation

AIM to determine whether diabetes mellitus(DM) affects prognosis/recurrence after liver transplantation(Lt) for hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC). METHODS A retrospective study was conducted between January 2000 and August 2013 on 1631 patients with HBV-related HCC who underwent Lt with antiviral prophylaxis. Patient data were obtained from the China Liver transplant Registry(https://www.cltr.org/). to compare the outcomes and tumor recurrence in the HBV-related HCC patients with or without DM, statistical analyses were conducted using χ2 tests, Mann-Whitney tests, the Kaplan-Meier method, log-rank tests and multivariate step-wise Cox regression analysis. RESULTS Univariate analysis of 1631 patients who underwent Lt found overall 1-, 3- and 5-year survival rates of 79%, 73% and 71% respectively in the DM patients, and 84%, 78% and 76% in the non-DM patients respectively. Overall survival rate differences after Lt between the two groups were significant(P = 0.041), but recurrence-free survival rates were not(P = 0.096). By stratified analysis, the overall survival rates in DM patients for age 50 years(P = 0.002), the presence of vascular invasion(P = 0.096), tumors ≤ 3 cm(P = 0.047), two to three tumor nodules(P = 0.007), Child-Pugh grade B(P = 0.018), and preLt alanine aminotransferase levels between 40 and 80 IU/L(P = 0.017) were significantly lower than in non-DM patients. Additionally, serum α-fetoprotein level 2000 ng/m L(P = 0.052) was associated with a significant survival difference trend between DM and non-DM patients. Multivariate analysis showed that the presence of DM(P 0.001, HR = 1.591; 95%CI: 1.239-2.041) was an independent predictor associated with poor survival after Lt. CONCLUSION HBV-related HCC patients with DM have decreased long-term overall survival and poor Lt outcomes. Prevention strategies for HCC patients with DM are recommended.     

空腹和餐后手指末梢血糖与静脉血糖浓度差异的比较分析

目的分析比较空腹和餐后2h手指末梢全血、血浆与静脉全血、血浆4种不同血样葡萄糖浓度之间的差异。方法2010年8月至12月共140例1型或2型糖尿病患者纳入试验。其中男56例、女84例,年龄（54±10）岁。空腹血糖82例．餐后2h血糖58例,每例患者采集手指末梢全血、血浆以及静脉全血、血浆4种血样。用OneTouchVerio血糖监测系统和YSI2300葡萄糖测定仪,分别检测末梢血血糖（CBG）、静脉血糖（VBG）与末梢血浆血糖（CPG）、静脉血浆血糖（VPG）。并对Verio血糖监测系统的精准性进行评估。血糖数值差异分析采用配对t检验法。结果Verio血糖监测系统的精准性符合IS015197（2003）标准要求。空腹状态下血糖仪检测的CBG与VBG分别为（6．7±2．4）、（6．7±2．3）mmol／L,相对误差为0．40％（t=0．62,P〉0．05）,YSI检测的CPG与VPG分别为（6．4±2．5）、（6．4±2．4）mmol／L,相对误差为0．25（t=0．39,P〉0．05）,CBG略高于VPG5．89％（P〈0．05）;餐后2hCBG明显高于VBG,分别为（8．5±3．6）、（7．9±3．6）mmol／L,相对误差为7．58％（t=9．55,P〈0．05）;CPG亦明显高于VPG水平,分别为（8．1±3．8）、（7．6±3．8）mmol／L,相对误差为6．08％（t=10．9,P〈0．05）,CBG高于VPG11．6％（P〈0．05）。结论OneTouchVerio血糖监测系统适合临床对患者进行日常血糖检测,其检测的空腹CBG与VPG值较为接近,餐后CBG高于VPG值。