摘要：
Objective:To identify the risk factors for early mortality (≤30 days) in patients with ruptured naive hepatocellular carcinoma (HCC), including treatment modality. Methods:Between Jun 2012 and Dec 2016, the medical records of 80 ruptured naive HCC patients who received conservative treatment or transarterial embolization (TAE) as initial therapy from the authors' affiliated hospital were retrospectively analyzed. According to the survival state within 30 days, the selected patients were divided into the survival group and the dead group. An independent sample t-test was used for the continuity variables between the two groups, and the constituent ratios and rates were tested using the χ2 test. The possible risk factors related to early mortality were analyzed by using univariate and multivariate logistic regression model (P＜ 0. 05). Results:Of 80 patients, the early mortality was 28. 8％. Univariate analysis showed that the proportion of patients with shock on admission (P=0. 008), conservative treatment (P＜ 0. 001), poor Child-Pugh class (P＜ 0. 001) and advanced modified tumor stage of the liver cancer study group of Japan (LCSGJ) (P＜ 0. 001) in the dead group was significantly higher than those in the survival group, and the patients' initial hemoglobin level of the dead group (P＜ 0. 001) was also significantly lower than that of the survival group. Multivariate Logistic regression analysis indicated that patients with shock on admission (OR=5. 543, P=0. 026), poor Child-Pugh class[class B (OR=10. 395, P=0. 009) and class C (OR=23. 633, P=0. 006) ]and conservative treatment (OR=8. 576, P=0. 002) were independent risk factors for early mortality. Conclusion:Among ruptured naive HCC patients, the early mortality is high. For such patients, actively correcting shock while improving liver function as early as possible should undoubtedly have great significance for improving the prognosis. Additionally, reasonably expanding the indications of interventional therapy is essential.%目的:探讨初诊肝癌合并自发破裂出血患者早期死亡(生存期≤30 d)的危险因素及治疗方式的选择.方法:回顾性分析南京医科大学第一附属医院2012年6月—2016年12月,80例接受保守治疗或选择性动脉栓塞治疗的初诊肝癌自发破裂出血患者,根据患者30 d生存状态分成生存组及死亡组.两组间连续性变量采用独立样本t检验,构成比和率采用χ2检验,并将单因素分析阳性因素代入多变量Logistic回归模型,分析患者早期死亡的独立危险因素.结果:80例患者,早期病死率为28.8％.单因素分析显示死亡组患者休克比例(P=0.008)、初诊保守治疗比例(P＜0.001)、Child-Pugh分级(P＜0.001)、改良日本肝癌学组(LCSGJ)肿瘤分期(P＜0.001)明显高于生存组,死亡组患者初始血清血红蛋白水平(P＜0.001)明显低于生存组.多变量Logistic回归分析显示休克史(OR=5.543,P=0.026)、Child-Pugh分级较高[B级(OR=10.395,P=0.009)、C级(OR=23.633,P=0.006)]、初诊保守治疗(OR=8.576,P=0.002)是患者早期死亡的独立危险因素.结论:初诊肝癌合并破裂出血患者早期病死率高.在积极抗休克、尽可能挽救患者肝功能储备的同时,合理扩大介入治疗的适应证,可能为患者生存带来更多获益.
