慢性丙型肝炎病毒感染患者获得持续病毒学应答后肝细胞癌发生的危险因素
wf（2022）
Abstract
目的:探讨慢性丙型肝炎病毒(hepatitis C virus, HCV)感染患者进行抗病毒治疗获得持续病毒学应答(sustained virologic response，SVR)后肝细胞癌发生的危险因素。方法:纳入2012年1月至2019年4月在天津市第二人民医院治疗的慢性HCV感染患者，回顾性分析其肝细胞癌新发情况。采用Cox比例风险模型筛选影响患者发生肝细胞癌的危险因素。结果:644例慢性HCV感染患者中，慢性丙型肝炎421例(65.4%)，丙型肝炎肝硬化223例(34.6%)，新发肝细胞癌34例，均发生于肝硬化患者。Cox比例风险多因素分析显示：Child-Pugh分级B级以上[风险比(hazard ratio， HR)＝6.050，95%可信区间(confidence interval， CI) 2.658~13.771, P<0.001]、饮酒史( HR＝3.077, 95% CI 1.428~6.634， P＝0.004)、恶性肿瘤家族史( HR＝2.376，95% CI 1.155~4.888， P＝0.019)、年龄≥60岁( HR＝3.301，95% CI 1.563~6.974， P＝0.002)、受控衰减参数>292 dB/m( HR＝3.842, 95% CI 1.543~9.565， P＝0.004)是肝细胞癌的危险因素。 结论:慢性丙型肝炎尤其是肝硬化患者获得SVR后仍有发生肝细胞癌的风险。对于年龄≥60岁、Child-Pugh分级B级以上、存在重度脂肪肝、有饮酒史或恶性肿瘤家族史等高危因素的患者，更需加强肝细胞癌监测。
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Key words
Carcinoma, hepatocellular,Hepatitis C virus,Sustained virologic response,Risk factors
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