【作者】 杨帆；

【导师】 陈勇；

【作者基本信息】 第四军医大学 ， 外科学， 2010， 硕士

【摘要】 目的通过回顾性病例对照研究以及PS(Propensity score)研究方法,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。此外,针对该结果采用PS法进行分析,以年龄、性别及肝炎类别作为需均衡的协变量进行均衡并以是否有脾切除手术史分组,以1:2配对最终得到954例病例,其中合并脾切除手术史患者(组1),未合并脾切除手术史患者,对两组数据进行统计分析。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)。通过PS方法也证实了这一结论,既往有脾切除手术史组患者肝癌发生的比例(18.6%),明显低于没有脾切除手术史组患者肝癌发生的比例(31.8%),且有无发生肝癌在两组之间差异有统计学意义(P<0.05)。结论AST、ALP和GGT的异常升高则提示其肝癌发生的危险性增加。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,更多还原

【Abstract】 Object :To investigate the effects of hypersplenism and splenectomy procedure on hepatocarcinogenesis for posthepatitic cirrhosis patients and evaluate whether splenectomy can restrain the progress of hepatocarcinogenesis by retrospective case-control study and propensity score methods.Methods:2300 patients with posthepatitis cirrhosis and hypersplenism in our hospital from January 2002 to December 2008 were included in this study. The patients paired by 1:1 according to gender and age were divided into two groups: these cases with hepatocellular carcinoma(HCC) in group1 , without HCC in group2. Clinical datas and history of splenectomy plus porta-azygous disconection were collected. Univariate and multivariate logistic regression analysis of the impact of splenectomy on hepatocarcinogenesis were performed by SPSS17.0 Otherwise, PS matching techniques were used to adjust the age, gender and hepatitis variety, then take statistical analysis with the patients which were paired by 1:2 according to history of splenectomy into two groups: these cases with history of splenectomy plus porta-azygous disconection in group1, without history of splenectomy plus porta-azygous disconection in group2.Results:Statistical results showed that between group 1 and 2 there was statistically significant difference in albumin (ALB)、aspartate aminotransferase (AST)、total protein (TP)、alkaline phosphatase (ALP)、γ-glutamyltransferase (GGT) (P<0.05), but no statistically significant difference in alanine transarninase (ALT)、total bilirubin (TBIL), and platelet count(PLT)(P>0.05). Single-variable and multivariate analysis revealed that the patients with abnomal of AST,ALP, GGT increased the risk of hepatocarcinogenesis. Compareing patients with and without history of splenectomy plus porta-azygous disconection ,this procedure significant decrease the risk of hepatocarcinogenesis(Odds ratio,OR:0.571,Confidence interval of 95%: 0.394～0.825). And the result was justified by PS matching method, there was statistically significant difference in the proportion of hepatocarcinogenesis in the patients( P<0.05) , the patients with history of splenectomy plus porta-azygous disconnection was lower than the patients whithout history of splenectomy plus porta-azygous disconnection.Conclusions:This study showed that the abnomal of AST, ALP and GGT increased the risk of hepatic carcinoma in patients of posthepatitis cirrhosis with portal hypertension and hypersplenism. Splenectomy with porta-azygous disconection decreased the risk of hepatocarcinogenesis in these patients.更多还原