目的：研究抗 HCV 治疗后获得持续病毒学应答（SVR）发生肝癌（HCC）患者的临床特征。方法收集2006年至2014年郑州大学第一附属医院感染病科因慢性丙型肝炎入院抗病毒后获得 SVR 且未发生 HCC 的住院患者192例， SVR 后发生 HCC 患者11例，分析两组患者临床特征的差异。结果 HCC 组随访中位时间为17（10～39）个月，无 HCC 组为50（33～63）个月。HCC 组初始诊断 HCV 感染时以及抗病毒时疾病所处的阶段为代偿期肝硬化所占比例显著高于无HCC 组（54．5％比4．2％，P ＜0．01；63．6％比16．7％，P ＝0．001）；HCC 组病毒性肝炎家族史的比例显著高于无 HCC 组（100％比10．4％，P ＜0．01）；HCC 组 SVR 时白蛋白水平显著低于无 HCC 组[（35．0±6．0）g／L 比（41．3±4．7）g／L，P ＝0．001]；HCC 组 SVR 时甲胎蛋白水平显著高于无 HCC 组[（29．8±3．2）ng／mL 比（5．7±4．4）ng／mL，P ＜0．01]。结论初始诊断 HCV 感染时和抗病毒时患者为代偿期肝硬化、病毒性肝炎家族史、SVR 时低白蛋白水平以及 SVR 时较高甲胎蛋白水平可能是慢性丙肝患者 SVR 后 HCC 的危险因素。%Objective To investigate the clinical characteristics of hepatocellular carcinoma (HCC)in chronic hepatitis C (CHC)patients who had achieved a sustained virologic response (post-SVR HCC)to antivirus therapy.Methods Two hundred and three SVR-achieving CHC inpatients in first affiliated hospital of Zhengzhou University from 2006 to 2014,including 192 post-SVR non-HCC cases (control group)and 11 post-SVR HCC cases (case group),were enrolled to analyze their clinical characteristics.Results The median follow-up periods of case group and control group were 17.0 (10.0-39.0 )and 50.0 (33.0-63.0 )months,respectively. When compared to those in control group,there were significantly higher rates of preliminary diagnosis as compensated cirrhosis and antiviral therapy initiated in compensated cirrhosis in case group (54.5% vs.4.2%,P <0.001 ;63.6% vs.16.7%,P =0.001),higher proportion of family history of hepatitis (100% vs.10.4%,P <0.001 ),lower post-SVR albumin level (35.0 ±6.0 g/L vs.41 .3 ±4.7 g/L,P =0.001),higher post-SVR alpha fetal protein level (AFP)in case group (29.8 ±3.2 ng/mL vs.5.7 ±4.4 ng/mL,P <0.001),respectively.Conclusion Preliminary diagnosis as compensated cirrhosis,antiviral therapy initiated in compensated cirrhosis,family history of hepatitis,low post-SVR albumin level and high post-SVR AFP level may be risk factors for the occurrence of HCC in CHC patients who had achieved SVR to anti-HCV therapy.
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