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目的了解血吸虫性肝纤维化转变为肝癌的影响因素,为更好的防治该病奠定基础。方法通过问卷调查、临床病历资料分析以及相关实验室检查,比较单纯纤维化组和肝纤维化癌变组各项指标的区别。结果长期吸烟、饮酒的患者其肝纤维化进展为肝癌几率显著高于非吸烟、饮酒患者(吸烟:χ2=4.762,P<0.05;饮酒:χ2=25.073,P<0.05)。肝炎病毒感染显著提高了纤维化患者的癌变率(χ2=6.663,P<0.05)。病原学指标中,感染机会的多少与癌变率有关,感染次数多的患者的癌变率为19.1%,显著高于感染次数少的患者(χ2=20.545,P<0.05)。长期接触疫水的患者其癌变率也显著高于非长期接触疫水的患者(χ2=6.227,P<0.05)。随着反应纤维化程度指标的升高,癌变率逐渐升高(TGF-β1:t=27.414,P<0.05;TIMP-1:t=20.463,P<0.05)。其他一些因素如肝细胞损伤的严重程度以及患者的免疫状况也影响血吸虫性肝纤维化的癌变几率。结论血吸虫性肝纤维化的癌变与生活习惯(吸烟、饮酒)、感染机会多少以及患者病变程度有关。在治疗中应该采取综合措施,加强指标监测,改善患者预后。
Objective To understand the influencing factors of schistosomiasis hepatic fibrosis into hepatocellular carcinoma and lay the foundation for better prevention and treatment of this disease. Methods By questionnaire survey, clinical medical records data analysis and related laboratory tests, the difference between the simple fibrosis group and the liver fibrosis cancerous group indicators. Results Long-term smoking and drinking had a significantly higher risk of developing liver cancer than non-smoking and drinking patients (smoking: χ2 = 4.762, P <0.05; drinking: χ2 = 25.073, P <0.05). Hepatitis virus infection significantly increased the rate of canceration in patients with fibrosis (χ2 = 6.663, P <0.05). In the etiological indexes, the number of opportunistic infections was related to the rate of canceration. The rate of canceration was 19.1% in patients with more infections than those with less infections (χ2 = 20.545, P <0.05). Patients with prolonged exposure to water had a significantly higher rate of canceration than those without long-term exposure to water (χ2 = 6.227, P <0.05). With the increase of fibrosis degree, the rate of carcinogenesis increased gradually (TGF-β1: t = 27.414, P <0.05; TIMP-1: t = 20.463, P <0.05). Other factors, such as the severity of hepatocellular injury and the patient’s immune status, also affect the risk of cancer in schistosome-induced liver fibrosis. Conclusions The incidence of schistosomiasis-induced liver fibrosis is related to lifestyle (smoking and drinking), the chance of infection, and the extent of the patient’s disease. In the treatment should take comprehensive measures to strengthen the monitoring indicators to improve patient outcomes.