aMAP评分评估门诊慢性HBV感染者肝细胞癌风险的价值分析

王丽旻; 张鸿飞; 甘雨; 谢思; 王静月; 黄缘

doi:10.3969/j.issn.1001-5256.2022.10.009

aMAP评分评估门诊慢性HBV感染者肝细胞癌风险的价值分析

DOI: 10.3969/j.issn.1001-5256.2022.10.009

王丽旻^a,
张鸿飞^a,
甘雨^a,
谢思^b,
王静月^b,
黄缘^b, , ,

a.
清华大学附属北京清华长庚医院儿童肝病科，北京 102218
b.
清华大学附属北京清华长庚医院肝胆胰内科，北京 102218

伦理学声明：本研究方案于2021年5月26日经由北京清华长庚医院伦理委员会审批，批号：21228-0-01(2021-5-26)。患者均签署知情同意书。

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。

作者贡献声明：王丽旻、张鸿飞负责课题设计，资料分析，撰写论文；甘雨、王静月、谢思参与收集数据，修改论文；黄缘负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
黄缘, hya01515@btch.edu.cn

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出版历程
- 收稿日期: 2022-03-30
- 录用日期: 2022-05-14
- 出版日期: 2022-10-20

Value of aMAP score in prediction of hepatocellular carcinoma risk in outpatients with chronic hepatitis B virus infection

a.
Department of Children's Liver Diseases, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
b.
Department of Hepatobiliary and Pancreatic Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, China

More Information

Corresponding author: HUANG Yuan, hya01515@btch.edu.cn(ORCID: 0000-0003-4402-5771)

摘要

摘要: 目的探索肝细胞癌(HCC)风险预测模型aMAP评分对门诊慢性HBV感染者肝细胞癌风险评估的应用价值。方法选取2018年1月—2021年12月于北京清华长庚医院门诊就诊的慢性HBV感染者709例，计算aMAP及进行HCC风险评估。符合正态分布的计量资料组间比较采用t检验，等级资料两组间比较采用Mann-Whitney U检验。结果 709例慢性HBV感染者中，22.4%合并酒精性肝病，11.8%合并糖尿病。18.6%合并脂肪肝，19.0%合并肝硬化，9.7%合并肝癌。71.2%的患者服用口服抗病毒药物，28.8%未用抗病毒药物。aMAP最高为75.2分，HCC低、中和高风险人数分别占70.0%、23.1%和6.9%；合并酒精性肝病、糖尿病、肝硬化患者aMAP高风险的比例高于无酒精性肝病、糖尿病、肝硬化患者(9.4% vs 6.2%，11.9% vs 6.2%，19.3% vs 4.0%)，高中低风险组成比较，差异有统计学意义(P值分别为＜0.01, 0.01，＜0.01)。抗病毒治疗组患者aMAP变化的年均值(-1.15±1.72)分，明显低于未用抗病毒治疗者的(0.93±2.05)分(t=39.36，P＜0.01)。HCC患者确诊前3年内高风险的比例分别为38.4%、26.7%、33.3%。aMAP在确诊HCC前3年均＞50分，早于AFP的升高。结论 aMAP评分作为慢性HBV感染者HCC筛查管理的工具，简单快捷，便于门诊的应用。合并酒精性肝病、肝硬化的慢性HBV感染者aMAP评分的HCC高风险比例高于无合并疾病患者的比例，口服抗病毒治疗可降低aMAP。
- 癌, 肝细胞 /
- 乙型肝炎病毒 /
- aMAP评分
Abstract: Objective To assess the aMAP risk in prediction of hepatocellular carcinoma (HCC) risk in outpatients with chronic hepatitis B virus (HBV) infection. Methods A total of 709 patients with chronic HBV infection were recruited for calculation of the aMAP scores and then stratified for HCC risk statistically. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results Among these 709 patients, 22.4% had complicated with alcoholic liver disease, 11.8% with diabetes mellitus. 18.6% with fatty liver, 19.0% with liver cirrhosis, and 9.7% with liver cancer. Among all patients, 71.2% received oral antiviral medicine. Moreover, the highest aMAP score was 75.2 and the low, medium and high HCC risks were 70.0%, 23.1%, and 6.9% respectively in these patients. The proportion of patients with high HCC risk was higher among those with alcohol liver disease, diabetes mellitus, and liver cirrhosis than those without these complications (9.4% vs 6.2%; 11.9% vs 6.2%; and 19.3% vs 4.0%). The mean annual change in aMAP score was 0.93±2.05 in patients without antiviral treatment that was higher than -1.15±1.72 in patients with antiviral treatment (t=39.36; P < 0.001). In addition, the proportion of these patients with high HCC risk three years before HCC diagnosis was 38.4%, 26.7%, and 33.3% respectively. The median of aMAP score was more than 50 three years before diagnosis liver cancer, data of which indicated that this change was earlier than that of AFP. Conclusion aMAP is a simple convenient marker for screening early HCC in outpatient with chronic HBV infection and complications, especially in those patients with alcohol liver disease, diabetes, and cirrhosis. Oral antiviral therapy could reduce aMAP in patients with chronic HBV infection.
- Carcinoma, Hepatocellular /
- Hepatitis B Virus /
- aMAP Score

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图 1 HCC确诊前3年以及治疗后复发与否的AFP与aMAP变化

Figure 1. AFP and aMAP in HCC patients before diagnosis HCC 3 years and after treatment recurrence or not

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表 1 各亚组aMAP评分的高、中、低风险人数分布及比例

Table 1. Distribution and proportion of high, medium and low risk with aMAP score in each subgroup

项目	高风险(n=49)	中风险(n=164)	低风险(n=496)	U值	P值
性别[例(%)]				-0.42	0.67
男	21(5.0)	105(25.0)	294(75.0)
女	28(9.7)	59(20.4)	202(69.9)
乙型肝炎家族史[例(%)]				-0.22	0.83
有	16(5.0)	81(25.2)	224(69.2)
无	33(8.5)	83(21.4)	272(70.1)
肝癌家族史[例(%)]				-0.03	0.97
有	11(6.0)	44(19.8)	127(74.0)
无	38(7.2)	120(22.8)	369(70.0)
合并酒精性肝病[例(%)]				-4.25	＜0.01
有	15(9.4)	55(34.6)	89(56.0)
无	34(6.2)	109(19.8)	407(74.0)
合并糖尿病[例(%)]				-2.59	0.01
有	10(11.9)	25(29.8)	49(58.3)
无	39(6.2)	139(22.2)	447(71.5)
合并脂肪肝[例(%)]				-0.32	0.74
有	6(4.5)	33(25.0)	93(70.4)
无	43(7.5)	131(22.7)	403(69.8)
合并肝硬化[例(%)]				-8.99	＜0.01
有	26(19.3)	56(41.5)	53(39.2)
无	23(4.0)	108(18.8)	443(77.2)
合并HCC[例(%)]				-4.75	＜0.01
有	6(8.7)	33(47.8)	30(43.5)
无	43(6.7)	131(20.5)	466(72.8)
抗病毒治疗[例(%)]				-0.33	0.74
有	27(5.4)	124(24.8)	350(69.9)
无	22(10.6)	40(19.2)	146(70.2)
ALT[例(%)]				-6.02	＜0.01
＜40 U/L	6(3.0)	22(10.7)	177(86.3)
≥40 U/L	43(8.5)	142(28.2)	319(63.2)
HBeAg[例(%)]				-5.06	＜0.01
阳性	5(3.0)	18(11.0)	141(86.0)
阴性	44(8.1)	146(26.8)	355(65.1)
HBV DNA[例(%)]				-4.83	＜0.01
＜30 IU/mL	13(4.2)	52(16.6)	248(79.2)
≥30 IU/mL	36(9.1)	112(28.3)	248(62.6)
HBsAg[例(%)]				-9.11	＜0.01
≤247 IU/mL	21(3.9)	92(17.3)	420(78.8)
＞247 IU/mL	28(15.9)	72(40.9)	76(43.2)

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表 2 HCC患者确诊前1、2、3年的aMAP评分

Table 2. aMAP of HCC patients before diagnosised 1-3 years

组别	例数	高风险[例(%)]	中风险[例(%)]	低风险[例(%)]
诊断HCC前3年	13	5(38.5)	3(23.0)	5(38.5)
诊断HCC前2年	15	4(26.7)	4(26.7)	7(46.7)
诊断HCC前1年	15	5(33.3)	6(40.0)	4(26.7)
诊断HCC时	69	6(8.7)	33(47.8)	30(43.5)

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