發(fā)布時(shí)間：2018-05-06 18:13

  本文選題：原發(fā)性肝癌 + 回顧性流行病學(xué)　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)對(duì)我院診斷為原發(fā)性肝癌住院患者的病歷資料收集及數(shù)據(jù)分析,了解近年來(lái)原發(fā)性肝癌患者的臨床特征和預(yù)后影響因素。方法:回顧性流行病學(xué)調(diào)查:首先通過(guò)計(jì)算機(jī)檢索我院在2014年10月1日-2016年9月30日住院的原發(fā)性肝癌(Primary liver cancer,PLC)患者277例,查閱其住院病歷,登記有關(guān)指標(biāo):人口學(xué)資料、特殊不良嗜好、既往病史、腫瘤病理學(xué)特征、影像學(xué)結(jié)果等相關(guān)資料,探索近年流行病學(xué)特征情況以及預(yù)后影響因素的組成,用描述性統(tǒng)計(jì)學(xué)方法對(duì)研究結(jié)果進(jìn)行描述,借SPSS19.0軟件進(jìn)行數(shù)據(jù)處理,以P0.05為顯著差異。結(jié)果:1.277例肝癌患者中,男性患者有215例,女性相對(duì)較少為62例,男:女=3.47:1。2.肝癌患者中:HBV感染者197例(71.1%),HCV感染者21例(7.5%),17例(6.1%)有可疑用藥史,酒精性肝病者7例(2.5%),HBV/HCV感染占1例,HBV/酒精性肝病2例,自身免疫性肝癌占1例,其他原因相關(guān)性肝癌患者占31例。3.合并癥:肝硬化病史者184例,肝炎患者39例,高血壓43例、糖尿病40例、冠心病5例。4.肝癌初治患者中,AFP(200ng/ml)陽(yáng)性率42%。5.乙肝血清學(xué)標(biāo)志:HBsAg、HBeAb及HBcAb陽(yáng)性者71例(39.0%);HBsAg和HBc Ab陽(yáng)性48例(24.3%);HBsAg、HBeAg及HBcAb陽(yáng)性21例(10.6%);其余類(lèi)型占28.9%。6.肝癌診斷前HBV感染者行抗HBV治療有30例(15.3%),治療后轉(zhuǎn)陰的有22例,未進(jìn)行抗病毒治療的有166例(84.6%),HCV感染患者有抗病毒病史的3例(15%),行抗病毒治療后病毒均為陰性,未進(jìn)行抗病毒治療的有17例(85%)。7.初次診斷肝癌213例,單發(fā)109例(51.2%),多發(fā)89例(41.7%),單葉累及肝右葉111例(52.1%),肝左葉47例(22.0%),尾狀葉5例(2.3%),肝門(mén)6例(2.8%),累及兩肝葉以上38例(17.8%)。8.肝功能級(jí)別、BMI、BCLC期次,癌組織大小、甲胎蛋白、有無(wú)肝硬化是影響患者生存期的單因素。9.BMI、BCLC分期、肝硬化、腫瘤大小是影響肝癌患者生存期獨(dú)立因素,其中BMI是保護(hù)因素,BCLC期次、肝硬化、腫瘤大小是危險(xiǎn)因素。10.對(duì)于有治療指征患者,綜合治療組12月、36月和60月存活率均高于介入組,綜合治療組生存時(shí)間長(zhǎng)于單純TACE組。結(jié)論:1.我省近年來(lái)原發(fā)性肝癌,男性患病所占比例高,HBV感染為其主要病因,其次為藥物性肝損害、HCV感染、飲酒、其他因素等。2.初發(fā)肝癌患者腫瘤多為單發(fā),肝右葉累積較多。3.肝癌初治患者中,AFP(200 ng/ml)陽(yáng)性率44%,預(yù)測(cè)診斷肝癌有一定局限性,需探究覆蓋面更廣的標(biāo)志物。4.HBV病毒復(fù)制與肝癌發(fā)生關(guān)系:對(duì)于大多數(shù)肝癌患者雖然病毒復(fù)制呈現(xiàn)穩(wěn)定狀態(tài),病毒血清學(xué)示HBe Ab陽(yáng)轉(zhuǎn)者,甚至HBsAg轉(zhuǎn)陰者、HBVDNA陰性,仍有發(fā)生肝癌的可能,因此對(duì)于HBV相關(guān)性的肝癌,提倡早期抗病毒治療,減少HBV整合等機(jī)會(huì),避免導(dǎo)致肝癌發(fā)生。5.對(duì)于肝癌患者,保持良好營(yíng)養(yǎng)狀態(tài),防止肝功能失代償,控制瘤體增長(zhǎng),有肝硬化者積極抗肝纖維化治療,可有效延長(zhǎng)患者生存期。6.對(duì)于有治療指征肝癌患者,綜合治療方案能有效提高患者存活率。
[Abstract]:Objective: to study the clinical features and prognostic factors of patients with primary liver cancer (HCC) in recent years by collecting and analyzing the medical records of patients with primary liver cancer (PHC) diagnosed in our hospital. Methods: a retrospective epidemiological survey was conducted. First, 277 patients with primary liver cancer in our hospital from October 1, 2014 to September 30, 2016 were searched by computer. Special bad habits, past medical history, tumor pathological features, imaging results and other relevant data, the epidemiological characteristics in recent years and the composition of prognostic factors were explored. Descriptive statistics were used to describe the results of the study. SPSS19.0 software for data processing, P0.05 as a significant difference. Results of the 1. 277 HCC patients, 215 were male and 62 were females. Male: female: 3. 47: 1. 2. Of the 197 patients with hepatocellular carcinoma, 197 were infected with HBV and 21 were infected with HCV (7.5and 17 / 6.1), 7 patients with alcoholic liver disease accounted for 1 HBV / alcoholic liver disease, 1 patient was autoimmune liver cancer, and 31 patients with other related liver cancer were found to have a history of drug use, among them 7 patients with alcoholic liver disease accounted for 1 patient with HBV / alcoholic liver disease, 1 patient with autoimmune liver cancer, and 31 patients with liver cancer associated with other causes. Complications: 184 cases of liver cirrhosis, 39 cases of hepatitis, 43 cases of hypertension, 40 cases of diabetes, 5 cases of coronary heart disease. The positive rate of AFP 200 ng / ml in patients with primary liver cancer was 42. 5%. There were 71 cases (39.0%) with HBeAb and HBcAb positive in hepatitis B serological marker. There were 48 cases with positive HBsAg and HBc Ab in 48 cases and 21 cases with HBeAg positive and HBcAb positive in 21 cases, and the rest type accounted for 28.9%. Before diagnosis, 30 patients with HBV infection were treated with anti-HCV therapy, 22 patients turned negative after treatment, and 3 patients without antiviral therapy had a history of antiviral infection. All of them were negative after antiviral therapy. There were 17 cases without antiviral therapy. There were 213 cases of primary diagnosis of liver cancer, 109 cases of primary hepatic carcinoma and 51.2% of carcinoma, 89 cases of which were 41.7%, 111 cases of single lobe involved right lobe of liver, 47 cases of hepatic Zuo Ye were involved in right lobe of liver, 47 cases were involved in 22.0 cases, 5 cases of caudate lobe were involved with 2.3T, 6 cases of hilum of liver were 2.8B, and 38 cases were above two lobes of liver. Liver function grade BMI-BCLC stage, cancer tissue size, alpha-fetoprotein, liver cirrhosis are the single factors that affect the survival of patients. Liver cirrhosis, tumor size is an independent factor affecting the survival of patients with liver cancer, among which BMI is the protective factor of BCLC stage. Liver cirrhosis, tumor size is a risk factor. 10. For patients with indications of treatment, the survival rate of the combined treatment group was higher than that of the interventional group in 12 months, 36 months and 60 months, and the survival time of the combined treatment group was longer than that of the simple TACE group. Conclusion 1. In recent years, the primary liver cancer in our province is mainly caused by high incidence of HBV infection in males, followed by HCV infection with drug induced liver damage, alcohol consumption, other factors and so on. 2. Primary liver cancer patients are mostly single tumor, liver right lobe accumulation is more. 3. The positive rate of AFP 200 ng / ml in patients with primary liver cancer is 44%. Prediction of liver cancer has some limitations. It is necessary to explore the relationship between HBV virus replication and liver cancer occurrence. 4. For most patients with liver cancer, although virus replication shows a stable state, it is necessary to explore the relationship between HBV virus replication and liver cancer occurrence. Virus serology showed that HBe Ab positive conversion, or even HBsAg negative, still had the possibility of developing liver cancer. Therefore, early antiviral therapy should be advocated to reduce the chance of HBV integration so as to avoid the occurrence of hepatoma. For patients with liver cancer, maintaining good nutritional status, preventing decompensation of liver function, controlling tumor growth, and active anti-hepatic fibrosis treatment in patients with liver cirrhosis can effectively prolong the survival time of patients. For patients with liver cancer, comprehensive therapy can effectively improve the survival rate.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.7

【參考文獻(xiàn)】

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1 戚彩;孟繁坤;鄭穎;張海英;穆曉潔;張Z，

本文編號(hào)：1853347