摘要
目的探讨HBV相关原发性肝癌(HBV-PLC)初治患者的临床特征及中医证候分布规律,为中西医结合防治HBV-PLC提供依据。方法回顾性分析2019年1月—2024年12月湖南中医药大学第一附属医院肝病科/感染性疾病科收治的99例HBV-PLC初治患者的临床资料。根据患者是否规范抗病毒治疗(规范抗病毒治疗时间≥3年),将其分为抗病毒组和未抗病毒组;根据HBeAg状态分为HBeAg阳性组和HBeAg阴性组。收集患者的人口学特征、实验室检查结果、影像学资料及中医证候资料,计算中性粒细胞-淋巴细胞比值(NLR)、Child-Pugh评分、CNLC分期。符合正态分布的计量资料2组间比较使用独立样本t检验;计数资料组间比较使用χ^(2)检验。结果99例HBV-PLC初治患者的平均年龄为(57.12±11.60)岁,72.7%的患者年龄集中于50~75岁,男女比例为5.2∶1。肝硬化患者占81.8%,67.7%的患者既往未行抗病毒治疗;HBV DNA阳性率为80.8%,HBeAg阳性率为18.2%,AFP阳性占比69.7%,Child-Pugh分级为A/B级的患者占89.9%。抗病毒组患者的肿瘤最大直径为(t=2.310,P=0.024)、HBV DNA阳性率(χ^(2)=14.006,P<0.001)及并发癌栓数目(χ^(2)=7.347,P=0.007)均显著低于未抗病毒组。HBeAg阴性组与HBeAg阳性组患者比较,Child-Pugh分级(χ^(2)=6.780,P=0.034)及CNLC分期(χ^(2)=8.746,P=0.033)差异均有统计学意义。99例HBV-PLC初治患者的中医证型以肝郁脾虚兼血瘀证(41.4%)、气虚血瘀证(22.2%)、湿热蕴结兼血瘀证(19.2%)为主。结论HBV-PLC初治患者以中老年男性为主,多合并肝硬化。规范抗病毒治疗可显著改善肿瘤负荷和病毒学应答,HBeAg阴性者肝功能代偿状态更佳,低蛋白血症多见于气虚血瘀证患者。
Objective To investigate the clinical features and traditional Chinese medicine(TCM)syndrome distribution of treatment-naïve patients with hepatitis B virus-related primary liver cancer(HBV-PLC),and to provide a basis for integrated traditional Chinese and Western medicine in the prevention and treatment of HBV-PLC.Methods A retrospective analysis was performed for the clinical data of 99 treatment-naïve HBV-PLC patients who were admitted to Department of Hepatology and Infectious Diseases in The First Affiliated Hospital of Hunan University of Chinese Medicine from January 2019 to December 2024.According to whether the patient received standardized antiviral therapy(for≥3 years),they were divided into antiviral group and non-antiviral group,and according to the status of HBeAg,they were divided into HBeAg-positive group and HBeAg-negative group.Demographic features,laboratory test results,imaging data,and TCM syndrome data were collected,and neutrophil-tolymphocyte ratio(NLR),Child-Pugh score,and CNLC stage were calculated.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the chi-square test was used for comparison of categorical data between groups.Results The 99 treatment-naïve HBV-PLC patients had a mean age of 57.12±11.60 years,and the patients aged 50-75 years accounted for the highest proportion of 72.7%,with a male/female ratio of 5.2∶1.The patients with liver cirrhosis accounted for 81.8%,and 67.7%of the patients did not receive antiviral therapy in the past.The positive rates of HBV DNA,HBeAg,and alpha-fetoprotein were 80.8%,18.2%,and 69.7%,respectively,and the patients with Child-Pugh class A/B disease accounted for 89.9%.Compared with the non-antiviral group,the antiviral group had a significantly smaller maximum tumor diameter(t=2.310,P=0.024),a significantly lower HBV DNA positive rate(χ^(2)=14.006,P<0.001),and a significantly lower number of tumor thrombi(χ^(2)=7.347,P=0.007).In addition,there were significant differences between the HBeAg-negative group and the HBeAg-positive group in Child-Pugh class(χ^(2)=6.780,P=0.034)and CNLC stage(χ^(2)=8.746,P=0.033).Among the 99 treatment-naïve HBV-PLC patients,41.4%had liver depression and spleen deficiency with blood stasis,22.2%had Qi deficiency and blood stasis syndrome,and 19.2%had damp-heat accumulation with blood stasis.Conclusion Treatment-naïve HBV-PLC patients are mainly middle-aged and elderly male individuals,and most of the patients are comorbid with liver cirrhosis.Standardized antiviral therapy can significantly reduce tumor burden and improve virologic response,with better hepatic compensation in HBeAg-negative patients,and hypoproteinemia is more common in patients with Qi deficiency and blood stasis syndrome.
作者
田涛
孙克伟
王熊
刘心如
曾维涛
袁维
TIAN Tao;SUN Kewei;WANG Xiong;LIU Xinru;ZENG Weitao;YUAN Wei(Department of Hepatology and Infectious Diseases,The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)
出处
《临床肝胆病杂志》
北大核心
2025年第11期2336-2342,共7页
Journal of Clinical Hepatology
基金
国家自然科学基金(81904182)
长沙市杰出创新青年培养计划(kq2209020)
湖南中医药大学优秀青年项目(2022XJB006)
湖南中医药大学研究生创新课题项目(2024CX113)。
关键词
乙型肝炎病毒
肝肿瘤
症状体征和证候
Hepatitis B Virus
Liver Neoplasms
Symptoms Signs and Syndrome
