| 陈永臻,常丽仙,刘春云,等.Child-Pugh评分 A级原发性肝癌病人发生门静脉癌栓风险预测[J].安徽医药,2025,29(12):2416-2422. |
| Child-Pugh评分 A级原发性肝癌病人发生门静脉癌栓风险预测 |
| Risk prediction of portal vein tumor thrombus in patients with Child-Pugh class A primary hepatic carcinoma |
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| DOI：10.3969/j.issn.1009-6469.2025.12.018 |
| 中文关键词: 乙型肝炎肝硬化 原发性肝癌 Child-Pugh A分级 门静脉癌栓 影响因素 受试者操作特征曲线 |
| 英文关键词: Hepatitis B virus cirrhosis Primary carcinoma of liver Child-Pugh A rating Portal vein cancer thrombus Influ-encing factors Receiver operating characteristic curve |
| 基金项目:云南省昆明市科技计划项目( 2024-1-NS-0035)；云南省昆明市卫生健康委员会科研基金资助项目( 2023-03-08-001) |
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| 中文摘要: |
| 目的探究乙型肝炎相关肝硬化后原发性肝癌( PHC)Child-Pugh评分 A级病人发生门静脉癌栓( PVTT)的影响因素并用受试者操作特征曲线( ROC曲线)进行风险预测。方法选择 2018年 1月至 2023年 12月在昆明市第三人民医院首次住院的 186例乙型肝炎相关肝硬化后 PHC Child-Pugh评分为 A级病人作为该研究的对象，回顾性分析研究对象的一般资料、血常规、血生化、 T淋巴细胞亚群、细胞因子、甲状腺功能以及乙型肝炎病毒标志物等指标。其中 67例确诊有 PVTT病人作为病例组， 119例未发生 PVTT的病人作为对照组。采用单因素分析和二元 logistic回归分析乙型肝炎相关肝硬化后 PHC Child-Pugh评分 A级病人发生 PVTT的影响因素，构建 ROC曲线，较为客观地反映其预测价值。结果 186例 PHC Child-Pugh A分级病人中男性 168例( 90.32%)、女性 18例( 9.68%)。单因素分析结果显示病例组与对照组在乙型肝炎家族史、白细胞、中性粒细胞(NEUT)、血小板、纤维蛋白原( FIB)、异常凝血酶原( PIVKA-Ⅱ)、天冬氨酸氨基转移酶( AST)、前白蛋白［( 142.48±44.79)mg/L比( 175.16±49.57)mg/L］、 γ-谷氨酰转移酶( GGT)［173.00(85.60，260.00)U/L比 58.00(34.50，99.40)U/L］、碱性磷酸酶( ALP)、胆碱酯酶、乙型肝炎病毒 DNA(HBV-DNA)、超敏 C反应蛋白( hs-CRP)、甲胎蛋白［ 1.53(0.78，3.57)lg IU/mL比 0.68(0.49，1.29)lg IU/mL］、甲状腺素(T4)、游离三碘甲状腺原氨酸( FT3)、游离甲状腺素( FT4)［(16.91±2.75)pmol/L比( 15.30±2.31)pmol/L］、甲状腺过氧化物酶抗体( TPO-Ab)、白细胞介素( IL)-5、α干扰素、 IL-6等方面差异有统计学意义( P<0.05)。二元 logistic回归分析结果表明前白蛋白、 GGT、甲胎蛋白、 FT4为乙型肝炎相关肝硬化后 PHC Child-Pugh评分为 A级病人发生 PVTT的独立影响因素。构建 ROC曲线显示前白蛋白、甲胎蛋白、 GGT、FT4的曲线下面积( AUC)分别为 0.31、0.71、0.81、0.66；上述 4个指标联合预测乙型肝炎相关肝硬化后 PHC Child-Pugh A级病人发生 PVTT的 AUC为 0.87。结论前白蛋白、甲胎蛋白、 GGT、FT4为乙型肝炎相关肝硬化后 PHC Child-Pugh A级病人发生 PVTT的独立影响因素，并且联合预测价值较高，对于此类病人发生 PVTT的预测具有一定的准确性。 |
| 英文摘要: |
| Objective To investigate the factors influencing the development of portal vein tumor thrombus (PVTT) in patients with Child-Pugh class A primary hepatic carcinoma (PHC) after developing hepatitis B-related cirrhosis and to predict the risks by receiver operating characteristic curve (ROC curve).Methods A total of 186 patients with Child-Pugh class A PHC after developing hepatitis B-related cirrhosis, who were first hospitalized in Kunming Third People's Hospital from January 2018 to December 2023, were select-ed as the subjects of this study. Retrospective analysis of general information, blood routine, blood biochemistry, T lymphocyte subsets,cytokine levels, thyroid function and hepatitis B virus markers were collected from the study subjects. Among them, 67 patients withconfirmed PVTT were assigned to case group and 119 patients without PVTT were assigned to control group. Univariate analysis and bi-nary logistic regression were used to analyze the influencing factors for PVTT in patients with Child-Pugh class A PHC after developing hepatitis B-related cirrhosis, and ROC was constructed to objectively reflect its predictive value.Results Among 186 patients with Child-Pugh class A PHC, 168 (90.32%) were male and 18 (9.68%) were female. Univariate analysis results showed that there were sta-tistically significant differences between the two groups in the family history of hepatitis B, white blood cell (WBC), neutrophil (NEUT),and platelet (PLT) counts, as well as levels of fibrinogen (FIB), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ), as-partate aminotransferase (AST), and prealbumin (PA) [(142.48±44.79) mg/L vs. (175.16±49.57) mg/L], Gamma-glutamyl transferase (GGT) [173.00 (85.60, 260.00) U/L vs. 58.00 (34.50, 99.40) U/L], alkaline phosphatase (ALP), cholinesterase (CHE), hepatitis B virusdeoxyribonucleic acid (HBVDNA), high-sensitivity C-reactive protein (hs-CRP), Alpha-fetoprotein (AFP) [1.53 (0.78, 3.57) lg IU/mL vs. 0.68 (0.49, 1.29) lg IU/mL], thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4) [(16.91±2.75) pmol/L vs. (15.30±2.31) pmol/ L], thyroid peroxidase antibody (TPO-Ab), interleukin-5 (IL-5), interferon-alpha (IFN-α) and interleukin-6 (IL-6) (P<0.05). Binary logis-tic regression analysis results showed that PA, GGT, AFP, FT4 were independent risk factors for PVTT in patients with Child-Pugh class A PHC after developing hepatitis B-related cirrhosis. The constructed ROC showed that the areas under the curve (AUC) of PA, AFP, GGT and FT4 were 0.31, 0.71, 0.81 and 0.66, respectively. The AUC of the combined prediction of the above four indicators was 0.87.Conclusion PA, AFP, GGT and FT4 are independent factors influencing the occurrence of PVTT in Child-Pugh class A PHC pa-tients with hepatitis B-related cirrhosis, and the combined prediction value is high, which achieves a certain accuracy in predicting PVTT in such patients. |
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