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高密度脂蛋白胆固醇对行根治性治疗的酒精相关性肝细胞癌患者预后的影响

张蕊 常秀娟 程家敏 赵志芹 李茵茵 陆荫英 曾珍

张蕊, 常秀娟, 程家敏, 等. 高密度脂蛋白胆固醇对行根治性治疗的酒精相关性肝细胞癌患者预后的影响[J]. 临床肝胆病杂志, 2021, 37(3): 621-626. DOI: 10.3969/j.issn.1001-5256.2021.03.023
引用本文: 张蕊, 常秀娟, 程家敏, 等. 高密度脂蛋白胆固醇对行根治性治疗的酒精相关性肝细胞癌患者预后的影响[J]. 临床肝胆病杂志, 2021, 37(3): 621-626. DOI: 10.3969/j.issn.1001-5256.2021.03.023
ZHANG R, CHANG XJ, CHENG JM, et al. Influence of high-density lipoprotein cholesterol on the prognosis of patients with alcohol-related hepatocellular carcinoma after radical treatment[J]. J Clin Hepatol, 2021, 37(3): 621-626. DOI: 10.3969/j.issn.1001-5256.2021.03.023
Citation: ZHANG R, CHANG XJ, CHENG JM, et al. Influence of high-density lipoprotein cholesterol on the prognosis of patients with alcohol-related hepatocellular carcinoma after radical treatment[J]. J Clin Hepatol, 2021, 37(3): 621-626. DOI: 10.3969/j.issn.1001-5256.2021.03.023

高密度脂蛋白胆固醇对行根治性治疗的酒精相关性肝细胞癌患者预后的影响

DOI: 10.3969/j.issn.1001-5256.2021.03.023
基金项目: 

国家科技重大专项课题 2018ZX10302205

详细信息
    作者简介:

    张蕊(1992—),女,主要从事肝癌的基础与临床研究

    通讯作者:

    曾珍,zengzhen1970@sina.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:张蕊负责课题设计,资料分析,撰写论文;赵志芹参与收集数据; 常秀娟、程家敏、李茵茵、曾珍参与修改论文;陆荫英、曾珍负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R735.7

Influence of high-density lipoprotein cholesterol on the prognosis of patients with alcohol-related hepatocellular carcinoma after radical treatment

  • 摘要:   目的  探索高密度脂蛋白胆固醇(HDL-C)与根治性治疗后酒精相关性肝细胞癌(HCC)患者预后的关系。  方法  回顾性分析2008年1月—2015年7月解放军总医院第五医学中心收治的43例接受根治性治疗的酒精相关性HCC患者临床资料,根据HDL-C水平分为正常组(n=26)及异常组(n=17)。比较2组间基本信息、实验室检验指标、影像学相关指标、肿瘤BCLC分期和肝功能Child-Pugh分级的差异。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料2组间比较采用Mann-Whithey U检验; 计数资料2组间比较采用χ2检验。Kaplan-Meier法绘制生存曲线,组间比较采用log-rank检验。采用单因素和多因素Cox比例风险模型探索预后相关的独立危险因素。  结果  2组间前白蛋白比较差异有统计学意义[(162.38±60.86) mg/L vs (120.06±64.08) mg/L, t=2.184, P=0.035];肿瘤数目(HR=2.839, 95%CI: 1.120~7.200, P=0.028)、肿瘤大小(HR=2.634, 95%CI: 1.062~6.529,P=0.037)及HDL-C水平(HR=2.400, 95%CI:1.040~5.537, P=0.040)是影响酒精相关性HCC患者总生存期的独立危险因素。HDL-C正常组的1、3、5年累积生存率分别为88.5%、72.4%、55.7%,HDL-C异常组分别为70.6%、43.7%、17.5%,2组累积生存率差异有统计学意义(χ2=5.881,P=0.015)。  结论  HDL-C水平的降低可能预示酒精相关性HCC患者预后较差。
  • 图  1  2组患者生存曲线

    表  1  2组临床相关指标的比较

    指标 HDL-C正常组(n=26) HDL-C异常组(n=17) 统计值 P
    年龄(岁) 63.42±9.12 60.41±10.24 t=1.009 0.319
    饮酒时间(年) 30.00(20.00~32.50) 20.00(20.00~30.00) Z=-0.812 0.417
    Alb(g/L) 36.50±4.60 33.76±6.22 t=1.658 0.105
    PAB(mg/L) 162.38±60.86 120.06±64.08 t=2.184 0.035
    ALT (U/L) 27.50(16.75~45.50) 27.00(14.50~55.50) Z=-1.007 0.314
    AST (U/L) 30.00(20.75~49.25) 35.00(22.00~63.00) Z=-0.087 0.931
    GGT (U/L) 78.00(30.50~177.50) 130.00(58.00~329.50) Z=-1.255 0.210
    ChE(U/L) 3813.31±314.17 3641.18±486.91 t=0.321 0.865
    AFP (ng/ml) 9.85(4.02~23.00) 14.80(5.84~288.45) Z=-1.329 0.184
    饮酒量[例(%)] χ2=0.029 0.865
      少量(40~80 g/d) 8(30.8) 4(23.5)
      大量(>80 g/d) 18(69.2) 13(76.5)
    肝硬化[例(%)] χ2=0.616 0.432
      无 5(19.2) 1(5.9)
      有 21(80.8) 16(94.1)
    Child-Pugh分级[例(%)] χ2=4.710 0.062
      A级 15(71.4) 6(37.5)
       B级 6(28.6) 9(56.3)
      C级 0 1(6.3)
    BCLC分期[例(%)] χ2=3.081 0.357
       A期 17(65.4) 10(58.8)
      B期 6(23.1) 2(11.8)
       C期 3(11.5) 4(23.5)
      D期 0 1(5.9)
    肿瘤数目[例(%)] χ2=0 1.000
      单发 19(73.1) 13(76.5)
      多发 7(26.9) 4(23.5)
    肿瘤大小[例(%)] χ2=1.418 0.234
      <5 cm 17(65.4) 8(47.1)
       ≥5 cm 9(34.6) 9(52.9)
    血管侵犯[例(%)] χ2=2.197 0.138
       无 25(96.2) 13(76.5)
       有 1(3.8) 4(23.5)
    淋巴结转移[例(%)] χ2=0 1.000
       无 24(92.3) 16(94.1)
       有 2(7.7) 1(5.9)
    腹水[例(%)] χ2=2.833 0.092
       无 16(61.5) 6(35.3)
       有 10(38.5) 11(64.7)
    下载: 导出CSV

    表  2  Cox单因素和多因素分析

    项目 单因素分析 多因素分析
    HR(95%CI) P HR(95%CI) P
    年龄
      <60岁
       ≥60岁 1.588(0.649~3.886) 0.311
    饮酒量
       少量(40 ~80 g/d)
      大量(>80 g/d) 1.843(0.688~4.937) 0.224
    AFP
       正常组
       异常组 1.464(0.657~3.264) 0.351
    HDL-C
      >0.91 mmol/L
       ≤0.91 mmol/L 2.635(1.170~5.937) 0.019 2.400(1.040~5.537) 0.040
    肝硬化
       无
       有 1.218(0.357~4.152) 0.753
    Child-Pugh分级
       A级
       B级
       C级 1.557(0.797~3.040) 0.195
    BCLC分期
       A期
       B期
       C期
       D期 1.397(0.944~2.068) 0.095
    血管侵犯
       无
       有 2.132(0.760~5.979) 0.150
    淋巴结转移
       无
       有 1.864(0.530~6.554) 0.332
    肿瘤数目
      单发
      多发 4.002(1.613~9.929) 0.003 2.839(1.120~7.200) 0.028
    肿瘤大小
      <5 cm
       ≥5 cm 3.208(1.350~7.625) 0.008 2.634(1.062~6.529) 0.037
    治疗方式
       手术
       消融 0.516(0.219~1.218) 0.131
    下载: 导出CSV
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  • 收稿日期:  2020-09-07
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