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目的:通过回顾性病例对照研究,探讨多种因素在病毒性肝炎后肝化门静脉高压症患者HCC发生过程中的作用以及脾切除是否抑制了肝癌的发生进程。方法:收集第四军医大学西京医院病案统计室检索2002年1月～2008年12月之间出院诊断为病毒性肝炎后(HBV/HCV)肝硬化门脉高压的病例2300余例,收集所有病例的一般资料,临床及实验室检查数据,影象学检查结果,以及在治疗过程中的脾切除手术史。采用病例对照,按年龄、性别两个指标进行1:1配对,根据研究对象是否合并HCC将其分为合并HCC组(组1),未合并HCC组(组2),采用SPSS17.0进行单因素分析及多因素logistic回归分析。结果:描述性统计结果显示,两组的ALB、AST、TP、ALP、GGT等差异有统计学意义(P<0.05),而PLT、ALT、TBIL等在两组间差异无统计学意义(P>0.05)。将单因素分析有意义的研究因素纳入多因素logistic回归方程得知,AST、ALP、GGT异常升高增加了肝癌发生的危险性,而行脾切除和门奇断流术明显降低了肝癌发生的危险性,仅为无手术患者肝癌发生危险性的57.1%(OR:0.571,95%CI:0.394～0.825)。结论:脾切除和门奇断流术可显著降低肝炎后肝硬化伴门脉高压、脾功能亢进患者肝癌发生的危险性,AST、ALP和GGT的异常升高则提示其肝癌发生的危险性增加。
Objective: To investigate the role of multiple factors in the development of HCC in patients with liver cirrhosis and portal hypertension after splenectomy, and whether splenectomy can inhibit the progression of HCC by retrospective case-control study. Methods: A total of more than 2,300 cases of portal hypertension diagnosed as post-viral hepatitis (HBV / HCV) were collected from Xijing Hospital of Fourth Military Medical University from January 2002 to December 2008. All the cases were collected General information, clinical and laboratory data, imaging findings, and history of splenectomy during treatment. A case-control study was conducted with a 1: 1 pairwise analysis according to age and gender. According to whether the patients were combined with HCC, the patients were divided into combined HCC group (group 1), unincorporated HCC group (group 2) Factor analysis and multivariate logistic regression analysis. Results: The descriptive statistics showed that the ALB, AST, TP, ALP and GGT in the two groups had statistical significance (P <0.05), while there were no significant differences in the PLT, ALT and TBIL between the two groups > 0.05). Univariate analysis of significant factors into the multivariate logistic regression equation was informed that abnormal AST, ALP, GGT increased the risk of occurrence of liver cancer, and splenectomy and Menci cut significantly reduced the occurrence of liver cancer The risk was only 57.1% of patients with hepatocellular carcinoma (OR: 0.571, 95% CI: 0.394-0.825). Conclusions: Splenectomy and Menzied’s disconnection can significantly reduce the risk of liver cancer in cirrhotic patients with cirrhosis accompanied by portal hypertension and hypersplenism. The abnormal increase of AST, ALP and GGT may indicate the increased risk of liver cancer .