CAJ | 학술논문

目的探讨原发性肝癌自发性破裂出血的危险因素.方法将2003年7月至2011年7月温州医学院附属第三医院介入科收治的34例原发性肝癌自发性破裂出血患者归为研究组,从同期住院的215例原发性肝癌患者中随机抽取34例未破裂者归为对照组,将两组患者的一般情况、化验指标和影像资料进行回顾性对比研究,分析原发性肝癌自发性破裂出血的危险因素.结果单因素分析的结果显示,原发性肝癌患者的性别、年龄、肝功能Child-Turcotte-Pugh分级、巴塞罗那临床肝癌分期、乙肝两对半(HBsAg、HBsAb、HBeAg、HBeAb、HBcAb)、凝血酶原时间、凝血酶时间、国际标准化比值、血糖、肿瘤最大径、肿瘤位置以及肝硬化、门脉癌栓和胆囊炎或胆结石的发生情况均与自发性破裂出血无关(均P ＞0.05),但活化部分凝血活酶时间、纤维蛋白原和甲胎蛋白的水平以及肿瘤突出肝表面高度均与自发性破裂出血有关(均P ＜0.05).Logistic回归分析的结果显示,纤维蛋白原正常或偏低(P =0.033)以及肿瘤突出肝表面＞1 cm(P =0.041)是原发性肝癌自发性破裂出血的独立危险因素.结论纤维蛋白原正常或偏低和肿瘤突出肝表面＞1 cm是原发性肝癌自发性破裂出血的独立危险因素.
목적 탐토원발성간암자발성파렬출혈적위험인소.방법 장2003년7월지2011년7월온주의학원부속제삼의원개입과수치적34례원발성간암자발성파렬출혈환자귀위연구조,종동기주원적215례원발성간암환자중수궤추취34례미파렬자귀위대조조,장량조환자적일반정황、화험지표화영상자료진행회고성대비연구,분석원발성간암자발성파렬출혈적위험인소.결과 단인소분석적결과현시,원발성간암환자적성별、년령、간공능Child-Turcotte-Pugh분급、파새라나림상간암분기、을간량대반(HBsAg、HBsAb、HBeAg、HBeAb、HBcAb)、응혈매원시간、응혈매시간、국제표준화비치、혈당、종류최대경、종류위치이급간경화、문맥암전화담낭염혹담결석적발생정황균여자발성파렬출혈무관(균P ＞0.05),단활화부분응혈활매시간、섬유단백원화갑태단백적수평이급종류돌출간표면고도균여자발성파렬출혈유관(균P ＜0.05).Logistic회귀분석적결과현시,섬유단백원정상혹편저(P =0.033)이급종류돌출간표면＞1 cm(P =0.041)시원발성간암자발성파렬출혈적독립위험인소.결론 섬유단백원정상혹편저화종류돌출간표면＞1 cm시원발성간암자발성파렬출혈적독립위험인소.
Objective To assess the risk factors for spontaneous rupture of hepatocellular carcinoma (SRHC).Methods A retrospective analysis of 34 consecutive patients with SRHC treated by emergency interventional embolization in our hospital from July 2003 to July 2011 was conducted.General condition,laboratory examination and imaging data were analyzed,and compared with the data of 34 patients with primary hepatocellular carcinoma but without rupture,randomly selected from 215 concurrent patients.The patients with SRHC were selected for risk factor analysis,and the non-SRHC patients were taken as control group.Results No significant difference between the SRHC group and control group was found in age,sex,Child-Turcotte-Pugh (CTP) grade,Barcelona clinic liver cancer (BCLC) stage,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,prothrombin time (PT),thrombin time (TT),international normalized ratio (INR),glucose (GLU),cirrhosis,portal tumor thrombus,the maximum diameter of tumor,location,and cholecystitis or cholelithiasis.The univariate analysis showed that activated partial thromboplastin time (APTT),lower or normal plasma fibrinogen (FIB) level,alpha fetoprotein (AFP),tumor protrusion ＞ 1 cm above the liver surface were all associated with increased risk of SRHC (P ＜ 0.05).Multivariate analysis only showed that lower or normal level of FIB (P =0.033) and tumor protrusion ＞ 1 cm above the liver surface (P =0.041) were significant independent risk factors for SRHC.Conclusion Lower or normal level of FIB and tumor protrusion ＞ 1 cm above the liver surface are significant independent risk factors for spontaneous rupture of hepatocellular carcinoma.