發(fā)布時(shí)間：2018-05-27 07:26

  本文選題：乙肝 + 原發(fā)性肝癌　； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察抗病毒治療對乙肝相關(guān)性原發(fā)性肝癌患者臨床指標(biāo)的影響,客觀評價(jià)抗病毒治療的作用,以此說服拒絕抗病毒治療的此類患者應(yīng)當(dāng)進(jìn)行抗病毒治療;探討影響乙肝相關(guān)性原發(fā)性肝癌患者抗病毒療效的獨(dú)立影響因素,為臨床治療此類疾病提供一些理論和實(shí)踐依據(jù)。方法:回顧性分析2010年6月~2016年06月在廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院住院的首次診斷為乙肝相關(guān)性原發(fā)性肝癌患者的完整臨床資料,按納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選出418例患者納入本次研究。根據(jù)是否使用核苷(酸)類似物抗病毒治療,抗病毒藥物為首次使用,將238例進(jìn)行抗病毒治療的患者作為抗病毒組,將180例拒絕抗病毒治療的患者作為對照組。比較首診時(shí)、治療后3、6、12月兩組的相關(guān)臨床資料及指標(biāo),包括性別、年齡、個(gè)人史(吸煙史、飲酒史)、家族史、抗病毒藥物類型,主要臨床癥狀體征(肝區(qū)疼痛、消瘦、黃疸、腹水)、TBIL、ALB、ALT、AST、PT、AFP、HBe Ag、HBV DNA、Child-Pugh評分、影像學(xué)分型(塊狀型、結(jié)節(jié)型)、組織學(xué)病理分型(肝細(xì)胞型肝癌HCC、肝內(nèi)膽管細(xì)胞型肝癌ICC、混合型)。對可能影響抗病毒療效的主要相關(guān)因素進(jìn)行分析,對有顯著性差異的因素進(jìn)行單因素Logistic回歸分析,為達(dá)到控制混雜因素干擾的目的,再對單因素分析中P0.05的變量運(yùn)用多因素非條件Logistic回歸分析篩選出影響抗病毒療效的獨(dú)立影響因素。結(jié)果:(1)418例患者中男性有369例,女性49例,男女比例為7.53:1;平均年齡為(45.68±12.08)歲,45~59歲有131例,占31.34%,45歲有228例,其中≤30歲有29例,占該人群的12.72%。(2)兩組首診時(shí)相關(guān)臨床指標(biāo)比較無差異(P0.05);抗病毒治療3、6月后,抗病毒組較對照組在肝區(qū)疼痛緩解率、黃疸緩解率、腹水緩解率、PT縮短時(shí)間、TBIL、ALB、ALT、AST、AFP、HBV DNA、Child-Pugh評分、HCC、ICC等方面均獲得較明顯的改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05);抗病毒治療12月后,抗病毒組HBe Ag改善優(yōu)于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),抗病毒組AFP(38.56±17.82)u g/L、HBV DNA陰轉(zhuǎn)率89.50%,對照組分別為(252.59±132.23)u g/L、3.33%,比較有顯著性差異(P0.05);有肝癌家族史并行抗病毒治療患者78例,抗病毒6個(gè)月后,女性在TBIL、ALT、AFP、HBV DNA、Child-Pugh評分等方面的改善均優(yōu)于男性,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)單因素Logistic回歸分析顯示藥物類型、飲酒史、家族史、黃疸、腹水、PT、HBe Ag陽性、HBV DNA、Child-Pugh評分、塊狀型、HCC進(jìn)入多因素方程;多因素非條件Logistic回歸分析顯示藥物類型(OR=5.376,95%CI 1.842~34.259)、飲酒史(OR=5.629,95%CI 2.052~15.443)、HBe Ag陽性(OR=13.821,95%CI 4.217~45.292)、HBV DNA(OR=0.534,95%CI 0.343~0.829)、塊狀型(OR=5.424,95%CI 2.006~14.666)、HCC(OR=13.546,95%CI 4.341~42.264)均為影響抗病毒療效的獨(dú)立影響因素。結(jié)論:(1)乙肝相關(guān)性原發(fā)性肝癌患者男性明顯多于女性,以中年患者居多,但發(fā)病年齡年輕化明顯。(2)乙肝相關(guān)性原發(fā)性肝癌患者抗病毒治療可以明顯改善患者臨床癥狀體征,降低肝臟炎癥,穩(wěn)定肝功,快速抑制HBV復(fù)制,減少腫瘤的復(fù)發(fā),為此拒絕抗病毒治療的患者若進(jìn)行抗病毒治療將受益匪淺;有肝癌家族史的乙肝相關(guān)性原發(fā)性肝癌患者,女性抗病毒近期療效優(yōu)于男性。(3)藥物類型、飲酒史、HBe Ag陽性、HBV DNA、塊狀型、組織學(xué)病理類型為HCC等因素是影響抗病毒療效的獨(dú)立影響因素,飲酒史、HBV DNA、塊狀型、HCC是危險(xiǎn)因素,而藥物類型是保護(hù)因素,HBe Ag陽性可能是保護(hù)因素。
[Abstract]:Objective: To observe the effect of antiviral therapy on the clinical indexes of HCC patients and objectively evaluate the effect of antiviral therapy in order to persuade the patients who refuse antiviral therapy to carry out antiviral therapy and to discuss the independent factors affecting the antiviral effect of HB related primary liver cancer patients and to treat the clinical treatment. Some theoretical and practical basis was provided for the treatment of such diseases. Methods: a retrospective analysis was made of the complete clinical data of the first diagnosis of HCC patients hospitalized in the Guangxi University of traditional Chinese medicine, Guangxi, June 2010, which was first diagnosed as hepatitis B related primary liver cancer, and 418 patients were selected according to the criteria and exclusion criteria. No antiviral therapy was used for the use of nucleoside (acid) analogues. Antiviral drugs were used for the first time. 238 cases of antiviral treatment were used as antiviral groups. 180 patients who refused antiviral treatment were used as control group. The related bed data and indicators in group two 3,6,12 months after treatment were compared, including sex, age, and history of individual smoking (smoking history). Family history, family history, antiviral drugs, major clinical symptoms and signs (liver pain, emaciation, jaundice, ascites), TBIL, ALB, ALT, AST, PT, AFP, HBe Ag, HBV DNA, Child-Pugh score, image classification (lump type, nodular), histological type (hepatocellular carcinoma HCC, intrahepatic bile duct hepatocellular carcinoma, mixed type). The main related factors of antiviral effect were analyzed, single factor Logistic regression analysis was carried out on the factors with significant differences, in order to control the interference of confounding factors, and then the independent factors influencing the effect of antiviral effect were screened out by multi factor unconditional Logistic regression analysis on the variables of P0.05 in single factor analysis. (1) among the 418 cases, there were 369 men and 49 women, and the proportion of men and women was 7.53:1; the average age was (45.68 + 12.08) years, 131 cases in 45~59 years, 31.34% and 228 cases, of which there were 228 cases at the age of 45, and there was no difference in the related clinical indexes of the first visit of the group of 12.72%. (2) in the population (P0.05); after 3,6 months of antiviral treatment, the antiviral group was compared with the control group. The pain relief rate, the remission rate of jaundice, the remission rate of the jaundice, the remission rate of the ascites, the time of PT shortening, the TBIL, ALB, ALT, AST, AFP, HBV DNA, Child-Pugh score, HCC, ICC and so on, were significantly improved (P0.05). After the antiviral treatment in December, the antivirus group was better than the control group, and the difference was statistically significant. The negative conversion rate of AFP (38.56 + 17.82) u g/L and HBV DNA was 89.50%, and the control group was (252.59 + 132.23) u g/L, 3.33%, and there was a significant difference (P0.05). There were 78 patients with family history of liver cancer in parallel with antiviral therapy. After 6 months of antivirus, the improvement of women in TBIL, ALT, AFP, HBV, and other scores were all superior to men, and the difference was statistically significant Significance (P0.05). (3) single factor Logistic regression analysis showed that drug types, drinking history, family history, jaundice, ascites, PT, HBe Ag positive, HBV DNA, Child-Pugh score, lump type, HCC entered the multifactor equation; multifactor non conditional Logistic regression analysis showed drug type (OR=5.376,95%CI 1.842~34.259), drinking history HBe Ag positive (OR=13.821,95%CI 4.217~45.292), HBV DNA (OR=0.534,95%CI 0.343~0.829), lump type (OR=5.424,95%CI 2.006~14.666), HCC (OR=13.546,95%CI) are the independent factors affecting the effect of antiviral effect. Conclusion: (1) most of the patients with HCC were significantly more male than women, but the majority of the patients were middle-aged, but the majority of the patients were middle-aged patients. The age of onset is obvious. (2) antiviral therapy for HCC patients can obviously improve the clinical symptoms and signs, reduce liver inflammation, stabilize the liver function, quickly inhibit HBV replication and reduce the recurrence of tumor. Patients with hepatitis B related primary liver cancer were better than men in the near future. (3) drug types, drinking history, HBe Ag positive, HBV DNA, massive type, and histologic type of HCC are independent factors affecting the antiviral effect, drinking history, HBV DNA, lump type, HCC are risk factors, and drug type is a protective factor, HBe A G positive may be a protective factor.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62;R735.7

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