| 马晓燕,高远,万雨林,等.2型糖尿病对乙型肝炎相关性肝癌病人预后的影响[J].安徽医药,2024,28(10):2003-2009. |
| 2型糖尿病对乙型肝炎相关性肝癌病人预后的影响 |
| Effect of type 2 diabetes mellitus on the prognosis of patients with hepatocellular carcinoma associated with hepatitis B virus |
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| DOI：10.3969/j.issn.1009-6469.2024.10.020 |
| 中文关键词: 肝肿瘤 乙型肝炎病毒 糖尿病 预后 影响因素 |
| 英文关键词: Liver neoplasms Hepatitis B virus Diabetes mellitus Prognosis Influencing factors |
| 基金项目: |
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| 中文摘要: |
| 目的分析乙型肝炎相关性肝癌病人合并 2型糖尿病( T2DM)与否对其预后的影响。方法收集 2018年 8月至 2021年 6月在徐州医科大学附属医院就诊的 429例乙肝相关性肝癌病人，根据是否合并 T2DM，将其分为 T2DM组( 167例)和非 T2DM组( 262例)。比较两组病人的临床特征及预后情况。符合正态分布的计量资料组间比较采用独立样本 t检验，非正态分布的计量资料组间比较采用 Mann-Whitney U检验，计数资料组间比较采用 χ2检验或 Fisher确切概率法。采用 Kaplan-Meier法及 Log-rank绘制生存曲线， Cox比例风险回归模型进行单或多因素分析。 P<0.05为差异有统计学意义。结果乙肝相关性肝癌病人多因素 Cox回归分析显示 T2DM是影响其预后的危险因素［HR=1.38，95%CI:(1.08，1.76)P<0.05］。 T2DM组的生存时间为 10.0(2.0，27.0)个月显著低于非 T2DM组的 21.0(6.0，35.0)个月，差异有统计学意义(P<0.05)。，T2DM组第 1、2、3年的累积生存率( 46.7%、34.4%、25.5%)显著低于非 T2DM组( 61.0%、45.3%、31.3%)，差异有统计学意义( P<0.05)。 T2DM亚组分析显示:糖尿病病程 ≥10年组累积生存率低于糖尿病病程 <10年组( P=0.009)，HbA1c>7.4%组的累积生存率低于 HbA1c≤7.4%组( P=0.024)。合并 T2DM的乙肝相关性肝癌病人多因素 Cox回归分析显示:糖尿病病程 ≥10年［HR=1.62，95%CI:(1.12，2.35)］、 AFP ≥400 μg/L［HR=1.60，95%CI:(1.04，2.48)］和肝癌保守治疗( HR>1，P<0.05)是其预后的危险因素。结论 T2DM是影响乙肝相关性肝癌病人预后的危险因素，且糖尿病病程 ≥10年、 AFP≥400 μg/L和肝癌保守治疗的病人预后风险越大。 |
| 英文摘要: |
| Objective To analyze the influence of type 2 diabetes mellitus (T2DM) on the prognosis of patients with hepatitis B-related hepatocellular carcinoma.Methods From August 2018 to June 2021, 429 patients with HBV-related HCC in the Affiliated Hospital of Xuzhou Medical University were divided into the T2DM group (n=167) and non-T2DM group (n=262) according to whether theyhad T2DM or not. The clinical features and prognosis were compared between the two groups. The measurement data in normal distribution were compared by independent sample t-test, the measurement data in non-normal distribution were compared by Mann-Whitney U test, and the enumeration data were compared by chi-square test or Fisher exact probability method. Kaplan-Meier and Log-rank methods were used to draw survival curves, and Cox proportional hazard regression model was used to analyze single or multiple factors. The difference was statistically significant when P < 0.05.Results Multivariate Cox regression analysis showed that T2DM was a risk factor for the prognosis of HBV-related HCC [HR=1.38, 95% CI: (1.08, 1.76), P<0.05]. The median survival time in the T2DM group was 10.0 (2.0,27.0) months, which was significantly lower than that in the non-T2DM group 21.0 (6.0, 35.0) months(P<0.05). The 1,2,and 3-year cumulative survival rates in the T2DM group (46.7%, 34.4%, and 25.5%) were significantly lower than those in the non-T2DM group (61. 0%, 45.3%, and 31. 3%) (P<0.05). T2DM subgroup analysis showed that the cumulative survival rate of patientswith diabetes duration ≥ 10 years was lower than that of patients with diabetes duration < 10 years (P=0.009), and the cumulative survival rate of HbA1c>7.4% group was lower than that of HbA1c≤7.4% group (P=0.024). Multivariate Cox regression analysis showed that duration of diabetes mellitus ≥ 10 years[HR=1.62, 95% CI: (1.12, 2.35)], AFP≥400 μg/L [HR=1.60, 95% CI: (1.04, 2.48)], and conservative treatment (HR>1, P<0.05) were the risk factors for prognosis.Conclusion T2DM is a risk factor for the prognosis of patients with HBV-related HCC, and patients with a duration of diabetes≥10 years, AFP≥400 μg/L, and conservative treatment of HCC have agreater risk of prognosis. |
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