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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 104 -109. doi: 10.3877/cma.j.issn.1674-0793.2023.02.004

论著

代谢综合征与乙型肝炎病毒相关性肝细胞癌预后的危险因素分析
郑希彦1, 周正1, 何方平1, 林志群1, 杜飞1, 谢琴1, 王少平1, 史宪杰1,†()   
  1. 1. 518033　深圳，中山大学附属第八医院（深圳福田）肝胆胰外科
  • 收稿日期:2022-11-28 出版日期:2023-04-01
  • 通信作者: 史宪杰

Risk factors for the prognosis of metabolic syndrome and hepatitis B virus related hepatocellular carcinoma

Xiyan Zheng1, Zheng Zhou1, Fangping He1, Zhiqun Lin1, Fei Du1, Qin Xie1, Shaoping Wang1, Xianjie Shi1,†()   

  1. 1. Department of Hepatobiliary Pancreatic Surgery, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
  • Received:2022-11-28 Published:2023-04-01
  • Corresponding author: Xianjie Shi
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引用本文：

郑希彦, 周正, 何方平, 林志群, 杜飞, 谢琴, 王少平, 史宪杰. 代谢综合征与乙型肝炎病毒相关性肝细胞癌预后的危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(02): 104-109.

Xiyan Zheng, Zheng Zhou, Fangping He, Zhiqun Lin, Fei Du, Qin Xie, Shaoping Wang, Xianjie Shi. Risk factors for the prognosis of metabolic syndrome and hepatitis B virus related hepatocellular carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 104-109.

目的

分析代谢综合征（MetS）与乙型肝炎病毒（HBV）相关性肝细胞癌（HCC）关联，以及各代谢因素对疾病进展及预后的影响。

方法

收集2012年7月至2021年6月中山大学附属第八医院（深圳福田）收治的177例HCC合并HBV感染患者临床资料，根据是否合并MetS分为MetS +组（合并MetS）和MetS -组（未合并MetS）。收集患者的性别、年龄、实验室指标、肿瘤肝内转移、血管侵犯、肿瘤大小、淋巴结转移及远处转移情况进行对比，分析两组HCC患者的肿瘤进展差异，单因素和多因素Logistic回归分析MetS各代谢因素对HCC进展的影响。以Cox回归模型和Kaplan-Meier曲线进行生存分析。

结果

MetS+组76例（42.9%），MetS-组101例（57.1%）。MetS+组的肿瘤肝内转移发生率显著高于MetS-组（53.9% vs 28.7%，χ2=11.551，P=0.001）；多因素Logistic回归分析显示，血糖升高是影响HBV相关性HCC发生肝内转移的独立危险因素（OR=2.636，95% CI：1.356~5.126，P=0.004）。Cox回归模型分析显示，血糖升高患者死亡风险显著升高，相对危险度为2.081（P=0.006）。Kaplan-Meier曲线分析显示，血糖正常组患者总体生存显著优于血糖升高组，血糖升高患者预后较差（χ2=6.190，P=0.013）。

结论

MetS促进HBV相关性HCC的肝内转移，其代谢因素中血糖升高是促进肿瘤进展和肝内转移的独立危险因素，可增加HBV相关性HCC患者的死亡风险。

关键词: 代谢综合征, 肝细胞癌, 乙型肝炎病毒, 肿瘤进展, 危险因素
Objective

To analyze the relationship between metabolic syndrome (MetS) and hepatitis B virus (HBV) related hepatocellular carcinoma (HCC), and the influence of metabolic factors on disease progression and prognosis.

Methods

From July 2012 to June 2021, the clinical data of 177 patients with chronic HBV related HCC admitted to the Eighth Affiliated Hospital, Sun Yat-sen University were collected. According to whether MetS was combined, they were divided into MetS+ group and MetS-group. The gender, age, laboratory indicators, intrahepatic metastasis, vascular invasion, tumor size, lymph node metastasis and distant metastasis of the patients were compared, and the difference in tumor progression between the two groups was analyzed. Univariate and multivariate Logistic regression analysis were used to analyze the influence of metabolic factors of MetS on the progress of HCC. Cox regression model and Kaplan-Meier curve was used for survival analysis.

Results

There were 76 cases (42.9%) in MetS+ group and 101 cases (57.1%) in MetS-group. The rate of intrahepatic metastasis in the MetS+ group was significantly higher than that in the MetS-group (53.9% vs 28.7%, χ2=11.551, P=0.001). Elevated blood glucose was an independent risk factor for intrahepatic metastasis of HBV related HCC (OR=2.636, 95% CI: 1.356-5.126, P=0.004). Cox regression model analysis showed that the risk of death in HCC patients with elevated blood glucose was significantly increased and the relative risk was 2.081 (P=0.006). Kaplan-Meier curve showed that the overall survival of patients with normal blood glucose was significantly better than those with elevated blood glucose, poorer prognosis in patients with elevated blood glucose ( χ2=6.190, P=0.013).

Conclusions

MetS promotes the intrahepatic metastasis of HBV related HCC. Among its metabolic factors, elevated blood glucose is an independent risk factor for tumor progression and intrahepatic metastasis of HCC, which increases the death risk of patients with HBV related HCC.

Key words: Metabolic syndrome, Hepatocellular carcinoma, Hepatitis B virus, Tumor progression, Risk factor
表1 两组肝细胞癌患者临床资料比较
项目 MetS+组 MetS-组 统计值 P值
例数 76 101    
性别(男)a 69(90.8) 86(85.1) 1.268 0.260
年龄(岁) 56.57±11.58 55.63±13.03 0.494 0.622
体质量(kg) 70.22±10.67 61.78±9.15 5.660 <0.001b
腰围(cm) 92.69±5.78 87.89±5.68 5.523 <0.001b
体质指数(kg/m2) 24.51±3.27 22.16±2.48 5.442 <0.001b
空腹血清葡萄糖(mmol/L) 6.35±2.54 5.46±2.09 2.569 0.011b
γ-谷氨酰转移酶(U/L) 133.76±178.53 129.95±196.73 0.133 0.895
丙氨酸转氨酶(U/L) 50.44±61.97 46.06±55.04 0.496 0.621
天冬氨酸转氨酶(U/L) 60.70±62.54 58.13±75.68 0.239 0.811
总胆红素(μmol/L) 31.80±55.12 23.54±20.02 1.245 0.217
直接胆红素(μmol/L) 11.90±30.45 7.36±12.07 1.2284 0.223
白蛋白(g/L) 36.81±6.12 37.23±5.47 -0.485 0.628
高密度脂蛋白(mmol/L) 0.93±0.26 1.24±0.50 -5.360 <0.001b
三酰甘油(mmol/L) 1.49±0.81 0.94±0.36 5.609 <0.001b
总胆固醇(mmol/L) 4.46±1.34 4.80±1.82 -1.387 0.167
肝内转移a 41(53.9) 29(28.7) 11.551 0.001b
血管侵犯a 38(50.0) 50(49.5) 0.004 0.948
淋巴转移a 22(28.9) 20(19.8) 2.004 0.157
远处转移a 11(14.5) 7(6.9) 2.701 0.100
肿瘤大小(cm)a     1.045 0.307
>5 45(59.2) 52(51.5)    
≤5 31(40.8) 49(48.5)    
高三酰甘油血症a 27(35.5) 4(4.0) 29.911 <0.001b
低高密度脂蛋白胆固醇血症a 64(84.2) 35(34.7) 43.211 <0.001b
血压升高a 55(72.4) 25(24.8) 34.696 <0.001b
血糖升高a 44(57.9) 18(17.8) 30.600 <0.001b
表2 单因素及多因素Logistic回归分析肝细胞癌肝内转移的危险因素
因素 单因素分析 多因素分析
OR 95% CI P值 OR 95% CI P值
高三酰甘油血症a 1.731 1.062~2.823 0.028      
低高密度脂蛋白胆固醇血症b 1.767 0.952~3.279 0.071      
血压升高c 2.025 1.098~3.734 0.024      
血糖升高d 2.963 1.562~5.620 0.001 2.636 1.356~5.126 0.004
图1 血糖升高对乙型肝炎病毒相关性肝细胞癌患者生存期的影响
表3 MetS的组成因素与乙型肝炎病毒相关性肝细胞癌生存期的多因素分析
因素 B SE Wald P值 Exp(B)
中心型肥胖 -0.164 0.296 0.308 0.579 0.849
高三酰甘油血症 0.405 0.313 1.672 0.196 1.499
低高密度脂蛋白胆固醇血症 0.387 0.272 2.022 0.155 1.473
血压升高 -0.330 0.265 1.546 0.214 0.719
血糖升高 0.733 0.265 7.669 0.006 2.081
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