CAJ | 학술논문

目的：探讨在甲胎蛋白阴性（AFP≤20 ng/ml）的慢性乙型病毒性肝炎患者中瞬时弹性测定所测量的肝脏硬度值与原发性肝细胞癌（HCC）发生风险的关系。方法纳入2012年9月至2014年8月在第三军医大学第一附属医院就诊的81例患原发性HCC的慢性乙型病毒性肝炎患者作为病例组；同时纳入慢性乙型病毒性肝炎患者253例作为对照组，两组患者AFP测定均为阴性。采用瞬时弹性成像检查仪Fibroscan?测量所有患者的肝硬度值。二分类Logistic回归分析HCC发生风险的危险因素。计算分层特异性似然比（SSLR）。结果病例组患者的年龄、肝硬度值、血浆白蛋白中位数（25%，75%）分别为53岁（44，61）、12.00 kPa（7.50，20.75）、43.14 g/L（39.50，46.75）；对照组患者的年龄、肝脏硬度值、血浆白蛋白中位数（25%，75%）分别为45岁（38，56）、8.40 kPa（5.40，13.50）、46.40 g/L（43.75，48.50）；两组差异具有统计学意义（t=4.33、3.56、-4.48, P=0.00、0.00、0.00）。二分类Logistic回归分析表明年龄、性别、lg（肝硬度值）分别为肝癌发生的独立性预测因素（OR=1.053、2.432、6.803）。肝硬度值＜10 kPa，10.1~15 kPa，15.1~25 kPa，＞25 kPa时，HCC发生的SSLR值分别为0.67、1.02、1.44、3.98。结论瞬时弹性成像测量的肝硬度值可在AFP阴性的慢性乙型病毒性肝炎患者中提示HCC发生的风险，临床医师可据此对患者进行重点随访和临床干预。
목적：탐토재갑태단백음성（AFP≤20 ng/ml）적만성을형병독성간염환자중순시탄성측정소측량적간장경도치여원발성간세포암（HCC）발생풍험적관계。방법납입2012년9월지2014년8월재제삼군의대학제일부속의원취진적81례환원발성HCC적만성을형병독성간염환자작위병례조；동시납입만성을형병독성간염환자253례작위대조조，량조환자AFP측정균위음성。채용순시탄성성상검사의Fibroscan?측량소유환자적간경도치。이분류Logistic회귀분석HCC발생풍험적위험인소。계산분층특이성사연비（SSLR）。결과병례조환자적년령、간경도치、혈장백단백중위수（25%，75%）분별위53세（44，61）、12.00 kPa（7.50，20.75）、43.14 g/L（39.50，46.75）；대조조환자적년령、간장경도치、혈장백단백중위수（25%，75%）분별위45세（38，56）、8.40 kPa（5.40，13.50）、46.40 g/L（43.75，48.50）；량조차이구유통계학의의（t=4.33、3.56、-4.48, P=0.00、0.00、0.00）。이분류Logistic회귀분석표명년령、성별、lg（간경도치）분별위간암발생적독립성예측인소（OR=1.053、2.432、6.803）。간경도치＜10 kPa，10.1~15 kPa，15.1~25 kPa，＞25 kPa시，HCC발생적SSLR치분별위0.67、1.02、1.44、3.98。결론순시탄성성상측량적간경도치가재AFP음성적만성을형병독성간염환자중제시HCC발생적풍험，림상의사가거차대환자진행중점수방화림상간예。
ObjectiveTo investigate the relationship between liver stiffness and hepatocellular carcinoma (HCC) risk in chronic heptatitis B patients with negative α-fetoprotein (AFP) tests. MethodsFrom September 2012 to August 2014, this study enrolled a total of 82 HBV-relative native HCC patients as the case group. During the same period, a total of 253 chronic hepatitis B patients were also include in this study as the control group. These 253 patients were followed up for six months. All of the two groups were AFP-negative. Liver stiffness was measured in all patients by transient elastography device Fibroscan?. Logistic regression was applied to assess the risk of HCC incidence, and stratum-specific likelihood ratios (SSLR) was calculated.ResultsThe age, liver stiffness measurements and plasma albumin of patients in case group were 53 years old (44-61), 12.00 kPa (7.50-20.75), 43.14 g/L (39.50-46.75) respectively. The age, liver stiffness measurements and plasma albumin of patients in control group were 45 years old (38-56), 8.40 kPa (5.40-13.50), 46.40 g/L (43.75-48.50) respectively. The variables were compared between two groups with unpaired studentt test, and the results were statistically significant (t=4.33, 3.56, <br> -4.48,P=0.00, 0.00, 0.00). The patients in case group were older, and had higher liver stiffness measurements and lower plasma albumin than that of the patients in control group. Logistic regression analysis showed that HCC incidence was associated with age,male-gender and liver stiffness, and the odds ratios (OR) was 1.053, 2.432, 6.803 respectively. When liver stiffness was<10 kPa, 10.1-15 kPa, 15.1-25 kPa,>25 kPa, SSLR for HCC presence was 0.67, 1.02,1.44, 3.98 respectively.ConclusionsLiver stiffness measured by transient elastography is useful in predicting the risk of HCC incidence in AFP-negative chronic heptatitis B patients. Clinicians needed to carry out close follow-up and appropriate intervention for these patients.