瘦素与乙肝肝硬化基础上肝细胞癌发生的相关性研究

摘要

目的 探讨血清瘦素水平与乙肝肝硬化基础上的肝细胞肝癌发生的相关性及高瘦素患者临床特征.方法 ?在中法肝癌项目生物标本库中,选择232例乙肝肝硬化基础上的肝细胞癌初次诊断,将未经治疗患者作为观察组,以年龄相差3岁以内、相同性别、族别、肝功能Child-Pugh A为配对条件,按照1∶1比例,选择200例乙肝肝硬化患者配对作为对照组,用ELISA法测定所有患者血清瘦素水平,运用多因素二分类logistic回归的方法分析肝细胞癌发生相关因素;t检验分析肝细胞癌患者与肝硬化患者BMI＜23、BMI≥25二组之间ln(LP)水平组间差异.结果 ?在432例样本中,符合配对条件共95对,HCC组和肝硬化组年龄分别为(49.91±9.901)岁和(50.32±10.759)岁(P=0.785);男女比为77∶18;汉族、维吾尔族、哈萨克族比例均为92∶2∶1;肝细胞癌组合并肥胖和(或)2型糖尿病分别为26例(27%)、18例(19%),肝硬化组合并肥胖和(或)2型糖尿病分别为47例(49%)、6例(6%).瘦素、铁蛋白、C反应蛋白、甲胎蛋白、体质指数、2型糖尿病进入多因素二分类logistic回归方程,瘦素(OR=1.142,95%CI=1.020~1.278)、C反应蛋白(OR=1.028, 95%CI=1.000~1.057)、甲胎蛋白(OR=1.015,95%CI=1.007~1.024),体质指数(OR=0.875,95%CI=0.773~0.991).结论 ?血清瘦素水平是乙肝肝硬化基础上肝细胞癌发生的相关危险因素,血清瘦素水平升高可能是乙肝肝硬化合并肥胖等代谢性因素的血清标记物.%Objective This study is to investigate the correlation between the serum leptin level and the occurrence of hepatocellular carcinoma based on hepatitis B cirrhosis, as well as the clinical features of patients with high Leptin level. Methods In this prospective study, totally 232 cases of HCC based on hepatitis B cirrhosis were included, and another 200 age-gender-matched cirrhosis patients with Child-Pugh A liver function was recruited as the pair control group. Serum Leptin level was determined with ELISA. Multivariate logistic regression analysis was performed to investigate the possible related factors for HCC. Results Among these 432 subjects, totally 95 pairs were obtained and analyzed. The average ages for the HCC and cirrhosis groups were 49.91±9.901 and 50.32±10.759 years, with significant inter-group differences. The male to female ratio was 77/18, and the ratio of Han/ Uyghur/Kazak ethnicities was 92/2/1. For the HCC group, there were 26 patients (27%) combined with obesity and type II diabetes, and 18 patients (19%) combined with obesity or type II diabetes. For the cirrhosis group, there were 47 patients (49%) combined with obesity and type II diabetes, and 6 patients (6%) combined with obesity or type II diabetes. The multivariate logistic regression analysis involved Leptin, ferritin, CRP, AFP, BMI, and type II diabetes. Conclusion Serum Leptin level represents the risk factor for HCC based on hepatitis B cirrhosis, and elevated serum Leptin level might be the marker for hepatitis B cirrhosis combined with metabolic factors such as obesity.