目的: 分析乙型肝炎病毒(HBV)感染原发性肝癌患者的血常规指标与肝功能、HBV病毒载量以及预后不良的关系。方法: 选取2018年6月至2021年1月收治的肝癌患者124例,纳入肝癌组,并收集同期治疗及体检的肝硬化患者、健康者各100例,分别纳入肝硬化组、对照组,比较3组患者血常规指标[红细胞计数(RBC)、红细胞比容(HCT)、血红蛋白(Hb)含量、平均红细胞体积(MCV)、中性粒细胞与淋巴细胞比值(NLR)],并根据不同肝功分级、病毒载量、预后情况分组观察肝癌患者的血常规指标表达情况,分析肝癌患者预后不良的危险因素。结果: RBC、Hb、HCT从高至低依次为对照组、肝硬化组、肝癌组(P<0.05),MCV、NLR从高至低依次为肝癌组、肝硬化组、对照组(P<0.05);不同肝功分级肝癌患者的RBC、Hb、HCT从高至低依次为A级、B级、C级(P<0.05),MCV及NLR从高至低依次为C级、B级、A级(P<0.05);不同HBV病毒载量肝癌患者的RBC、Hb、HCT从高至低依次为低拷贝组、中拷贝组、高拷贝组(P<0.05),MCV及NLR从高至低依次为高拷贝组、中拷贝组、低拷贝组(P<0.05);预后良好组患者RBC、Hb、HCT高于预后不良组(P<0.05),MCV、NLR低于预后不良组(P<0.05);HBV病毒载量、MCV、NLR、RBC、Hb、HCT及肝功能分级均为HBV感染原发性肝癌患者预后不良的危险因素(P<0.05)。结论: HBV原发性肝癌患者的血常规指标与肝硬化患者、健康人有显著差别,且血常规指标与患者肝功能、HBV病毒载量及预后情况密切关联,应重视此类患者的血常规指标检测。
Objective: To analyze the relationship between blood routine indexes and liver function, HBV viral load and poor prognosis in patients with hepatitis B virus (HBV)-infected primary liver cancer. Methods: A total of 124 patients with liver cancer admitted from June 2018 to January 2021 were included in the liver cancer group, and 100 patients with liver cirrhosis and 100 healthy patients who received treatment and physical examination during the same period were included in the liver cirrhosis group and control group, respectively. The blood routine indexes (red blood cell count (RBC), red blood cell volume (HCT), hemoglobin (Hb) content, mean red blood cell volume (MCV), neutrophil-lymphocyte ratio (NLR)) of the three groups were compared, and the expression of blood routine indexes of liver cancer patients was observed in different groups according to different liver function grades, viral load and prognosis. The risk factors of poor prognosis in patients with liver cancer were analyzed. Results: RBC, Hb, HCT from high to low were the control group, the liver cirrhosis group, and the liver cancer group (P<0.05), and MCV and NLR from high to low were the liver cancer group, the liver cirrhosis group, and the control group (P<0.05). The RBC, Hb and HCT of liver cancer patients with different liver function grades were grade A, grade B and grade C from high to low (P<0.05), and the MCV and NLR were grade C, grade B and grade A from high to low (P<0.05). In liver cancer patients with different HBV viral load, RBC, Hb and HCT from high to low were successively low copy group, medium copy group and high copy group (P<0.05), and MCV and NLR from high to low were successively high copy group, medium copy group and low copy group (P<0.05). The RBC, Hb and HCT of good prognosis group were higher than those of poor prognosis group (P<0.05), while the MCV and NLR of good prognosis group were lower than those of poor prognosis group (P<0.05). HBV viral load, MCV, NLR, RBC, Hb, HCT and liver function grading were all risk factors for poor prognosis in patients with primary liver cancer infected with HBV (P<0.05). Conclusion: The blood routine indexes of patients with HBV primary liver cancer are significantly different from those of patients with cirrhosis and healthy people, and the blood routine indexes are closely related to the liver function, HBV viral load and prognosis of patients, so attention should be paid to the detection of blood routine indexes in these patients.
[1] 徐蓉, 华忠. 肝硬化并发原发性肝癌的流行病学特征、危险因素及相关预防干预对策研究[J]. 中西医结合肝病杂志, 2020, 30(4): 357-359, 366.
[2] 李富. 乙型肝炎性原发性肝癌患者乙肝病毒DNA载量与免疫功能的相关性[J]. 现代肿瘤医学, 2020, 28(14): 2474-2477.
[3] Yang WS, Zeng XF, Liu ZN, et al. Diet and liver cancer risk: a narrative review of epidemiological evidence[J]. Br J Nutr, 2020,124(3):330-340.
[4] 杨娜, 何华, 赵天业, 等. 红细胞分布宽度/血小板比值、血小板/淋巴细胞比值、中性粒细胞/淋巴细胞比值对慢性丙型肝炎肝硬化代偿期的预测价值[J]. 临床肝胆病杂志, 2021, 37(6): 1319-1325.
[5] 韩竖霞, 饶珺, 彭晓明, 等. 红细胞体积分布宽度在乙型肝炎相关原发性肝癌中的预测价值[J]. 中西医结合肝病杂志, 2021, 31(11): 1028-1030.
[6] 丁惠国, 屠红, 曲春枫, 等. 原发性肝癌的分层筛查与监测指南(2020版)[J]. 临床肝胆病杂志, 2021, 37(2): 25-40.
[6] 中华预防医学会肝胆胰疾病预防与控制专业委员会, 中国研究型医院学会肝病专业委员会, 中华医学会肝病学分会, 等. 原发性肝癌的分层筛查与监测指南(2020版)[J]. 临床肝胆病杂志, 2021, 37(2): 286-295.
[7] 陈光榆, 王鸿, 王耀晟, 等. 非酒精性脂肪性肝病患者血红蛋白水平变化及其临床意义[J]. 实用肝脏病杂志, 2021, 24(1): 39-42.
[8] 龙云祥, 曲凯, 张靖垚, 等. 肝细胞癌术前红细胞分布宽度的预后价值[J]. 中华消化外科杂志, 2021, 20(2): 205-212.
[9] 吴佳雨, 张秉强. 红细胞分布宽度在肝脏疾病中的应用进展[J]. 肝脏, 2021, 26(5): 563-565.
[10] 吴亦峰, 涂朝勇, 邵初晓. 血常规中炎症指标对肝细胞肝癌预后的价值[J]. 国际外科学杂志, 2020, 47(3): 206-211.
[11] 王伟仙, 曾莉, 周丰勤, 等. 原发性肝癌患者营养风险筛查及影响因素分析[J]. 护理学杂志, 2018, 33(19): 86-88.
[12] 蒋帆荣, 颜华东. HBV感染肝硬化失代偿期患者贫血情况调查及其对预后的影响[J]. 中华实验和临床病毒学杂志, 2020, 34(5): 547-550.
[13] 唐玉秀, 蒋世海, 吕永昌. 不同乙型肝炎病毒DNA载量对乙型肝炎相关性肝细胞癌患者肝功能的影响[J]. 中国综合临床, 2021, 37(2): 117-122.
[14] 李长贤, 张慧, 吴晓峰, 等. 不同中国肝癌分期肝癌根治性切除术后的临床效果及预后因素分析[J]. 中华外科杂志, 2021, 59(2): 134-143.