本文選題：肝癌 + 糖尿病��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的探究肝癌與糖尿病的相關(guān)性,分析糖尿病在肝癌的發(fā)生、肝癌伴HBV感染患者的治療、肝癌轉(zhuǎn)移過程中產(chǎn)生的不良影響,為有效預(yù)防肝癌的發(fā)生,避免糖尿病對(duì)肝癌患者產(chǎn)生的不良影響,提升肝癌患者的整體治療效果,改善預(yù)后提供科學(xué)指導(dǎo)。方法本研究選擇2013年1月至2014年1月在我院接受治療的70例糖尿病合并肝癌患者和70例單純肝癌患者為研究對(duì)象,將其設(shè)置為糖尿病組和非糖尿病組,回顧分析所有患者相關(guān)臨床資料信息。首先分析兩組患者一般資料的差異性,探究糖尿病對(duì)肝癌發(fā)生發(fā)展的整體影響;然后以兩組中的HBV感染和HCV感染患者為研究對(duì)象,分析糖尿病對(duì)HBV感染和HCV感染肝癌患者的影響;最后以兩組中采用手術(shù)治療的患者為研究對(duì)象,對(duì)比分析兩組患者的病理組織中NF-kBP65、pSTAT3/STAT3、NCOA5、CD34陽性表達(dá)情況,探究糖尿病對(duì)肝癌轉(zhuǎn)移的影響。在研究過程中,關(guān)于患者的結(jié)果相關(guān)數(shù)據(jù)使用SPSS21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行處理,計(jì)數(shù)單位和計(jì)量單位分別使用(%)和(±s)表示,對(duì)數(shù)據(jù)比較結(jié)果采用X2、t進(jìn)行檢驗(yàn),如果得出P0.05,則該研究數(shù)據(jù)比較具有統(tǒng)計(jì)學(xué)意義。在此基礎(chǔ)上采用Pearson相關(guān)分析對(duì)糖尿病與肝癌患者各項(xiàng)觀察指標(biāo)之間的相關(guān)性進(jìn)行研究,若P0.05,表示相關(guān)性較強(qiáng)。結(jié)果1.從整體分析來看,糖尿病組患者的年齡、腫瘤大小、合并有HBV感染和HCV感染患者百分比、BCLC分期中處于進(jìn)展期和終末期患者的百分比、門靜脈癌栓形成患者的百分比、發(fā)生消化道出血患者的百分比、發(fā)生病灶轉(zhuǎn)移的患者百分比均明顯高于非糖尿病組;而糖尿病組患者的生存期明顯低于非糖尿病組;以上各項(xiàng)指標(biāo)比較差異均顯著,(P0.05),具有統(tǒng)計(jì)學(xué)意義。兩組患者在性別方面比較差異不顯著,(P0.05),不具有統(tǒng)計(jì)學(xué)意義。將糖尿病與肝癌患者年齡、HBV感染、HCV感染、BCLC分期、門靜脈癌栓、消化道出血、病灶轉(zhuǎn)移、生存期之間的相關(guān)性進(jìn)行分析,研究發(fā)現(xiàn)糖尿病與肝癌患者的BCLC分期、門靜脈癌栓、消化道出血、病灶轉(zhuǎn)移、生存期之間關(guān)系密切,(P0.05)。2.對(duì)兩組中伴有HBV感染且僅采用TACE方法治療的患者進(jìn)行對(duì)比分析,糖尿病組患者中有48(68.57%)例,非糖尿病組中有25(35.71%)例。治療前,糖尿病組患者的白蛋白(ALB)水平明顯低于非糖尿病組,凝血酶原時(shí)間(PT時(shí)間)明顯高于非糖尿病組;從整體來看糖尿病組患者的Child-Pugh評(píng)分及分級(jí)明顯高于非糖尿病組,比較差異均顯著,(P0.05)。而兩組患者在丙氨酸轉(zhuǎn)氨酶(ALT)、天冬氨酸轉(zhuǎn)氨酶(AST)、總膽紅素(TBIL)等指標(biāo)方面比較差異不顯著,(P0.05),不具有統(tǒng)計(jì)學(xué)意義。治療后,糖尿病組患者的ALB、PT時(shí)間、Child-Pugh評(píng)分及分級(jí)、TBIL等指標(biāo)均明顯高于非糖尿病組,而在ALT和AST兩項(xiàng)指標(biāo)方面比較差異不顯著,(P0.05),不具有統(tǒng)計(jì)學(xué)意義。將糖尿病與肝功能各項(xiàng)指標(biāo)之間的相關(guān)性進(jìn)行分析,發(fā)現(xiàn)糖尿病與肝癌患者的Child-Pugh評(píng)分關(guān)系密切,P0.05。3.對(duì)兩組患者中單純采用手術(shù)方法治療的患者進(jìn)行對(duì)比研究分析,對(duì)比分析兩組患者病理組織中NF-kBP65、pSTAT3/STAT3、NCOA5、CD34表達(dá)情況,糖尿病組患者的病理組織中NF-kBP65、pSTAT3/STAT3、CD3陽性表達(dá)率情況平明顯高于非糖尿病組,而NCOA5陽性表達(dá)則明顯低于非糖尿病組,兩組之間比較差異顯著,(P0.05),有統(tǒng)計(jì)學(xué)意義。將糖尿病與NF-kBP65、pSTAT3/STAT3、NCOA5、CD34陽性表達(dá)之間的相關(guān)性進(jìn)行分析,研究發(fā)現(xiàn)糖尿病與各項(xiàng)病理指標(biāo)陽性表達(dá)之間的關(guān)系密切,(P0.05)。結(jié)論糖尿病與肝癌的發(fā)生發(fā)展密切相關(guān),是肝癌發(fā)生、發(fā)展的重要危險(xiǎn)因素,可能加重患者的病情分期,引發(fā)肝癌病灶轉(zhuǎn)移、門靜脈侵犯、消化道出血,導(dǎo)致HBV感染肝癌患者預(yù)后不良,誘發(fā)肝癌發(fā)展。在臨床當(dāng)中要關(guān)注糖尿病患者,防止其引發(fā)肝癌,對(duì)于糖尿病肝癌患者要予以針對(duì)性治療,并密切關(guān)注患者的病情發(fā)展情況,以控制病情,提升患者的預(yù)后水平。
[Abstract]:Objective to explore the correlation between liver cancer and diabetes, to analyze the adverse effects of diabetes in the occurrence of liver cancer, the treatment of the patients with HBV infection and the metastasis of liver cancer, to prevent the occurrence of liver cancer effectively, to avoid the adverse effects of diabetes on the patients with liver cancer, to improve the overall therapeutic effect and to improve the prognosis of the liver cancer patients. Methods 70 cases of diabetes combined with liver cancer and 70 patients with simple liver cancer in our hospital from January 2013 to January 2014 were selected as the subjects of the study. They were set up in the diabetes group and non diabetic group. The clinical information of all the patients was reviewed and analyzed. First, the difference of the general data of the two groups was analyzed. To explore the overall effect of diabetes on the development and development of liver cancer, and then to analyze the effect of diabetes on HBV infection and HCV infected patients with liver cancer in two groups of HBV infection and HCV infection. Finally, the patients in the two groups who were treated with surgical treatment were compared and analyzed in the pathological tissue of two groups of patients, NF-kBP65, pSTAT3/STA T3, NCOA5, CD34 positive expression, explore the effect of diabetes on the metastasis of liver cancer. In the course of the study, the data related to the outcome of the patients were treated with SPSS21.0 statistics software, and the counting units and measurement units were used (%) and (+ s) respectively, and the results were tested by X2 and t. If P0.05 was obtained, the study was made. The data were statistically significant. On this basis, Pearson correlation analysis was used to study the correlation between the various observation indexes of diabetes and liver cancer. If P0.05, the correlation was stronger. Results 1. from the overall analysis, the age of the patients in the diabetic group, the size of the tumor, the percentage of HBV infection and HCV infection, B The percentage of patients with advanced and end-stage CLC staging, the percentage of patients with portal vein thrombosis, the percentage of patients with gastrointestinal bleeding, and the percentage of patients with metastatic lesions were significantly higher than those in the non diabetic group, while the survival time of the diabetic group was significantly lower than that in the non diabetic group; the above indexes were all the difference in all the patients. Significant, (P0.05), with statistical significance. There was no significant difference in sex between the two groups. (P0.05), there was no statistical significance. The correlation between diabetes and liver cancer patients' age, HBV infection, HCV infection, BCLC staging, portal vein thrombus, digestive tract bleeding, lesion shift, survival time was analyzed, and diabetes and liver cancer were found. BCLC staging, portal vein thrombus, gastrointestinal bleeding, metastasis, and survival time were closely related, and (P0.05).2. was compared in two groups of patients with HBV infection and only treated with TACE, in the diabetic group, 48 (68.57%), and 25 (35.71%) in the non diabetic group. (ALB) was significantly lower than non diabetic group and prothrombin time (PT time) was significantly higher than that in non diabetic group. The Child-Pugh score and classification of patients with diabetes were significantly higher than those in non diabetic group (P0.05), and the two groups were in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBI). L) and other indicators, the difference was not significant, (P0.05), no statistical significance. After treatment, the ALB, PT time, Child-Pugh score and classification, TBIL of the diabetic group were significantly higher than those in the non diabetic group, but there was no significant difference between the two indexes of ALT and AST, (P0.05), not statistically significant. The correlation between the indexes was analyzed, and the Child-Pugh score of the patients with diabetes and liver cancer was closely related. P0.05.3. was compared and analyzed in the two groups of patients who were treated with surgical methods alone. The expression of NF-kBP65, pSTAT3/STAT3, NCOA5, CD34 in the pathological tissues of the two groups was compared and analyzed, and the patients in the diabetic group were compared and analyzed. The positive expression of NF-kBP65, pSTAT3/STAT3 and CD3 in the pathological tissue was significantly higher than that in the non diabetic group, while the positive expression of NCOA5 was significantly lower than that in the non diabetic group. The difference was significant between the two groups, (P0.05), and the correlation between the positive expression of diabetes and NF-kBP65, pSTAT3/ STAT3, NCOA5 and CD34 was analyzed. It is found that diabetes is closely related to the positive expression of various pathological indexes, (P0.05). Conclusion diabetes is closely related to the development and development of liver cancer. It is an important risk factor for the development of liver cancer. It may aggravate the stage of the patient's disease, cause the metastasis of the liver cancer, the invasion of the portal vein, the hemorrhage of the digestive tract, and lead to the preconditioning of the patients with HBV infection of the liver cancer. In the clinical, we should pay attention to the patients with diabetes, prevent it from causing liver cancer, to treat the patients with diabetes and liver cancer, and pay close attention to the development of the patient's condition in order to control the condition and improve the prognosis of the patients.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7;R587.1

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