| Background and objective:Hepatocellular carcinoma is one of common malignancy worldwide, and it can happen in all chronic liver disease and cirrhosis, especially in chronic heptatitis B patients and chronic heptatitis C patients. China is a country which has a great many chronic heptatitis B patients. Epidemiology survey showed that there are much more than twenty million patients with chronic heptatitis B. And there are fourty-five percent of new hepatocelluar carcinoma cases happening in China each year. Facing so huge quantity of chronic heptatitis B patients, medical institutions and medical workers at various levels care about how to monitor the presence of hepatocellular carcinoma and process early clinical interference subsequently in order to improve the patients’ life quality greatly. Most studes have demonstrated that the presence of hepatocellular carcinoma has a close relationship with the cirhosis which was caused by all kinds of reasons. First reported in 2003, a large number of studies had investigated that transient elastography could evaluate the level of liver fibrosis quickly and accurately, and transient elastography could assess the risk of hepatocellular carcinoma presence in chronic heptatitis C and chronic heptatitis B. However, risk assessment of hepatocellular carcinoma presence in patients with chronic hepatitis B whose α-fetoprotein test was negative has not been reported. The objective of this cross-sectional study is to investigated the relationship between liver stiffness measured by transient elastography and hepatocellular carcinoma presence.Subjects1.From October 2012 to February 2015, a total of 463 chronic heptatitis B patients were inclued in this study. We identified the chronic heptatitis B patients with native hepatocellular carcinoma as case group which have 194 patients(male 168 and female 26). A number of 269 chronic heptatitis B patients without hepatocellular carcinoma were included as control group in this study, and these 269 patients(male 204 and female 65) were followed up for six months in order to eliminate development of hepatocellular carcinoma.2.From September 2012 to August 2014, a total of 334 chronic heptatitis B patients were inclued in this study,and all of these patients’ α-fetoprotein test were negative. We identified the chronic heptatitis B patients with native hepatocellular carcinoma as case group which have 81 patients(male 72 and female 9). A number of 253 chronic heptatitis B patients without hepatocellular carcinoma were included as control group in this study, and these 253 patients(male 192 and female 61) were followed up for six months in order to eliminate development of hepatocellular carcinoma.MethodsAll patients were inspected by transient elastography, and made blood tests in one week. The blood tests included aspartate transaminase, alanine aminotransferase, total bilirubin, albumin, α-fetoprotein and blood platelet. We also calculated APRI(aspartate aminotransferase to platelet ratio index, APRI). Statiscical analysis was performed by SPSS software version 18.0. Using t-test to compare measurement data, and using chi-square test to compare enumeration data. Association with the presence of hepatocellular carcinoma was assessed by binary logistic regression analysis for each factors. We devided the liver stiffness into 4 rows and calculated the SSLR(stratum-specific likelihood ratio, SSLR). P value of <0.05 was considered statistically significant.Result1.In chronic heptatitis B patients, the patients with hepatocellular carcinoma were older, had higher liver stiffness, had lower plasma albumin than the patients without hepatocellular carcinoma. The case group had much higher male proportion.2. Logistic regression analysis showed age, male, positive positiveα-fetoprotein test and log10(liver stiffness) were independent predictors of hepatocellular carcinoma presence, and the OR(odds ratios, OR) was 1.049, 2.443, 135.319, 3.141 respectively.3. We devided the liver stiffness into 4 rows and calculated the SSLR.When liver stiffness was < 10.0k Pa, 10.1-15.0 k Pa, 15.1-25.0 k Pa, > 25.0 k Pa, SSLR for hepatocellular carcinoma presence was 0.57, 1.20, 1.49, 2.48 respectively.4. In chronic heptatitis B patients with negative α-fetoprotein test, the patients with hepatocellular carcinoma were older, had higher liver stiffness, had lower plasma albumin than the patients without hepatocellular carcinoma. The case group had much higher male proportion.5. In chronic heptatitis B patients with negative α-fetoprotein test, logistic regression analysis showed age, male and log10(liver stiffness) were independent predictors of hepatocellular carcinoma presence, and the OR was1.053, 2.432, 6.803 respectively.6. In chronic heptatitis B patients with negative α-fetoprotein test, we devided the liver stiffness into 4 rows and calculated the SSLR. When liver stiffness was <10.0k Pa, 10.1-15.0 k Pa, 15.1-25.0 k Pa, >25.0 k Pa, the SSLR for hepatocellular carcinoma presence was 0.67, 1.02, 1.44, 3.98 respectively.Conclusions1.In chronic heptatitis B patients, the patients with hepatocellular carcinoma were older, had higher liver stiffness and α-fetoprotein, had lower plasma albumin than the patients without hepatocellular carcinoma. The case group had much higher male proportion.2. In chronic heptatitis B patients, age, male, positive α-fetoprotein test and liver stiffness were independent predictors of hepatocellular carcinoma presence. Positive α-fetoprotein test was the strongest predictor of hepatocellular carcinoma presence.3. In chronic heptatitis B patients with negative α-fetoprotein test, age, male and liver stiffness were independent predictors of hepatocellular carcinoma presence. Liver stiffness was the strongest predictor of hepatocellular carcinoma presence.4. As the liver stiffness elevates, the risk of hepatocellular carcinoma presence was much higher. |
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