| 梁紫茵,周伟泽,黄秀明,等.分析基于 4项因素的肝纤维化指数值动态变化对恩替卡韦治疗慢性乙型肝炎肝硬化病人患肝癌风险的预测价值[J].安徽医药,2023,27(6):1211-1216. |
| 分析基于 4项因素的肝纤维化指数值动态变化对恩替卡韦治疗慢性乙型肝炎肝硬化病人患肝癌风险的预测价值 |
| Analysis of the predictive value of dynamic change of fibrosis index based on four factors on the risk of liver cancer in patients with chronic hepatitis B cirrhosis treated with entecavir |
| |
| DOI：10.3969/j.issn.10096469.2023.06.035 |
| 中文关键词: 乙型肝炎，慢性 肝硬化 癌症早期检测 肝纤维化指数 恩替卡韦 肝肿瘤 危险因素 |
| 英文关键词: Hepatitis B, chronic Liver cirrhosis Early detection of cancer FIB-4 index Entecavir Liver neoplasms Risk factors |
| 基金项目: |
|
| 摘要点击次数: 700 |
| 全文下载次数: 223 |
| 中文摘要: |
| 目的分析基于 4项因素的肝纤维化指数( FIB-4)值动态变化对恩替卡韦治疗的慢性乙型肝炎肝硬化病人患肝癌风险的预测价值。方法对 2016年 8月至 2019年 8月于惠州市第三人民医院感染内科收治的慢性乙型肝炎肝硬化病人 189例进行研究。所有病人给予恩替卡韦治疗，随访 2年后根据病人是否患肝癌分为肝癌组和对照组。比较两组的一般资料，实验室指标和 FIB-4等项目。采用多因素 logistic回归分析影响慢性乙型肝炎肝硬化病人患肝癌风险的相关因素，应用受试者操作特征( ROC)曲线分析 FIB-4等因素预测慢性乙型肝炎肝硬化患肝癌风险的价值。结果纳入研究的病人中有 17例病例脱落，剩余病例中有 41例出现肝癌，肝癌发生率为 23.83%。两组性别、血压、葡萄糖等临床资料对比差异无统计学意义( P>0.05)。但肝癌组肝硬化病程( 3.15±1.05)年大于对照组( 2.21±0.76)年( P<0.05)；肝癌组乙肝 DNA定量阳性率 46.34%(19/41)高于对照组 25.95%(34/131)(P<0.05)。两组入组时 FIB对比差异无统计学意义( P>0.05)，肝癌组入组 6个月后 FIB-4(3.92±1.06)、入组 12个月 FIB-4(4.03±1.11)、 1~6月 FIB-4值变化差值( 0.49±0.11)、 1~12月 FIB-4值变化差值( 0.64±0.19)、 1~6月 FIB-4值变化比(15.78±3.17)%、1~12月 FIB-4值变化比( 18.88±3.21)%均大于对照组 3.40±0.96、3.54±1.03、0.36±0.08、0.46±0.14、(10.41± 2.63)%、(14.94±3.34)%(均 P<0.05)；肝癌组 6~12月 FIB-4值变化差值( 0.11±0.03)和 6~12月 FIB-4值变化比( 2.81±0.87)均小于对照组(0.14±0.04、3.53±1.12)(均 P<0.05)。两组入组时和入组 6个月的肝脏弹性测定值( FibroScan值)对比差异无统计学意义(P>0.05)；肝癌组入组 12个月 FibroScan值(9.34±1.52)高于对照组( 8.76±1.16)(P<0.05)。多因素 logistic回归分析显示:肝硬化病程［ OR=4.31，95%CI:(1.34，13.82)］、乙肝 DNA定量［ OR=7.19，95%CI:(1.15，44.88)和 1~6月 FIB-4值变化比［ OR=1.92， 95%CI:(1.37，2.70)］是慢性乙型肝炎肝硬化病人发展为肝癌风险的独立危险因素。 ROC曲线显示: 1~6月 FIB-4值变化比预测慢性乙型肝炎肝硬化病人患肝癌风险的诊断效能高于肝硬化病程和乙肝 DNA定量，此时最佳截点为 >13.32，此时灵敏度为82.9%，特异度为 89.3%。结论在 1~6个月监测 FIB-4值动态变化对预测慢性乙型肝炎肝硬化病人患肝癌风险有较高的价值，有助于临床早期调整治疗方案。 |
| 英文摘要: |
| Objective To analyze the predictive value of dynamic changes of fibrosis index based on the 4 factors (FIB-4) on the risk of liver cancer in patients with chronic hepatitis B cirrhosis treated with entecavir.Methods A total of 189 patients with chronichepatitis B cirrhosis admitted to the Department of Infectious Diseases of the Third People′s Hospital of Huizhou from August 2016 toAugust 2019 were studied. All patients were treated with entecavir and were divided into liver cancer group and control group according to whether they developed liver cancer after 2 years of follow-up. General information, laboratory indicators and FIB-4 items were compared between the two groups. Multivariate Logistic regression was used to analyze the relevant factors affecting the risk of livercancer in patients with chronic hepatitis B cirrhosis, and ROC curve was used to analyze the value of FIB-4 and other factors in predicting the risk of liver cancer in patients with chronic hepatitis B cirrhosis.Results Among the patients included in the study, 17 casesfell off, and 41 of the remaining cases had liver cancer. The incidence of liver cancer was 23.83 %.There was no significant differencein gender, blood pressure, glucose and other clinical data between the two groups (P>0.05). Howere, the duration of cirrhosis in HCC group (3.15±1.05) years was longer than that in control group (2.21±0.76) years (P<0.05). The positive rate of HBV DNA in HCC group 46.34% (19/41) was higher than that in control group 25.95% (34/131) (P<0.05). There was no significant difference in FIB between the two groups at enrollment (P>0.05). The FIB-4 value in liver cancer group was (3.92±1.06) after 6 months, (4.03±1.11) after 12months, (0.49±0.11) from January to June, (0.64±0.19) from January to December, the change ratio of FIB-4 value from January to June (15.78±3.17) %, the change ratio of FIB-4 value from January to December (18.88±3.21) % were higher than the control group 3.40±0.96, 3.54±1.03, 0.36±0.08, 0.46±0.14, (10.41±2.63) %, (14.94±3.34) % (all P<0.05). The difference (0.11±0.03) and the change ratio (2.81±0.87) of FIB-4 value in the liver cancer group from June to December were smaller than those in the control group (0.14±0.04, 3.53±1.12) (P<0.05). There was no significant difference in liver elasticity (FibroScan value) between the two groups at admission and 6months after enrollment (P>0.05). At 12 months after enrollment, the FibroScan value of liver cancer group was higher than that of control group (8.76±1.16) (P<0.05). Multivariate Logistic regression analysis showed that duration of cirrhosis [OR=4.31, 95%CI: (1.34, 13.82)], DNA quantification of hepatitis B [OR=7.19, 95%CI: (1.15, 44.88)], and change ratio from January to June [OR=1.92, 95%CI: (1.37, 2.70)] were independent risk factors for developing HCC in patients with chronic hepatitis B cirrhosis. ROC curve showed thatthe change ratio of FIB-4 values 1 to 6 months in predicting the risk of liver cancer in patients with chronic hepatitis B cirrhosis washigher than that of the course of liver cirrhosis and HBV DNA quantification. At this point, the optimal cut-off point was >13.32,the sensitivity and specificity were 82.9% and 89.3% respectively.Conclusion Monitoring the dynamic changes of FIB-4 values from January to June is of high value for predicting the risk of liver cancer in patients with chronic hepatitis B cirrhosis, and it is helpful to adjustthe early clinical treatment regimen. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
