Objective: To investigate the proportion of hepatitis B-related hepatocellular carcinoma (HCC) patients who have received antiviral therapy and compare the clinical characteristics of HCC patients who have received antiviral therapy with those who have not received antiviral therapy. Methods: Data of 2590 newly diagnosed hepatitis B-related HCC cases who were hospitalized in Nanfang Hospital from 2015 to 2017 were collected. Two independent sample t-tests, Mann-Whitney U test, and χ(2) test were used to compare the clinical characteristics of hepatitis B-related HCC patients who had received antiviral therapy and those who had not received antiviral therapy. Propensity score was used to match some clinical characteristics of the two groups of patients, and the differences in clinical characteristics of the two groups of patients after matching were further compared. Patients with HCC who had not received antiviral therapy were used as reference, and then the clinical characteristics of HCC patients who had received antiviral treatment were analyzed using multivariate logistic regression. Results: Among the 2 590 patients with hepatitis B-related HCC, only 18.10% of patients had received antiviral therapy, while 82.20% of patients who did not receive antiviral therapy met the treatment criteria. HCC patients who had received antiviral therapy were older (P < 0.05), had a higher proportion of liver cirrhosis (P < 0.001), and lower levels of platelets and alanine aminotransferases and smaller maximum tumor diameter (P < 0.001). In terms of metabolic disease, patients who had received antiviral treatment had higher prevalence of diabetes (14.50% vs. 7.70%, P < 0.001), hypertension (16.60% vs. 11.20%, P < 0.05), obesity (28.50% vs. 22.30%, P < 0.05), overweight (53.80% vs. 43.50%, P < 0.001) and non-alcoholic fatty liver disease (18.30% vs.8.00%, P < 0.001). After matching other different clinical characteristics, the prevalence of diabetes, hypertension, and non-alcoholic fatty liver disease in patients who received antiviral therapy was still higher than that of patients who did not receive antiviral therapy (14.50% vs. 9.80%, P < 0.05; 16.60% vs. 10.20%, P < 0.05; 18.30% vs. 7.00%, P < 0.001). Multivariate logistic regression analysis showed that HCC patients who had received antiviral therapy had a higher risk of developing non-alcoholic fatty liver disease (OR: 2.054, 95% CI: 1.404~3.004) than those who had not received antiviral therapy. Conclusion: Among patients with hepatitis B-related HCC, the proportion of patients who have received antiviral therapy is significantly low (under 20%), which suggests that the popularization and promotion of antiviral therapy has a long way to go. Compared with HCC patients who have not received antiviral therapy, the proportion of HCC patients who have received antiviral therapy combined with metabolic diseases is higher; therefore, it is necessary to pay more attention to the role of metabolic factors in the pathogenesis of hepatitis B-related HCC.
目的： 调查乙型肝炎相关的肝细胞癌（HCC）患者中，接受过抗病毒治疗的患者比例并比较接受过抗病毒治疗与未接受过抗病毒治疗的HCC患者临床特征。 方法： 收集2015年至2017年在南方医院住院并首次诊断的乙型肝炎相关HCC患者资料2 590例。采用两独立样本t检验，Mann-Whitney U检验，χ(2)检验，比较接受过抗病毒治疗与未接受过抗病毒治疗的乙型肝炎相关HCC患者的临床特征。采用倾向性评分方法匹配两组患者的某些临床特征，进一步比较匹配后两组患者的差异临床特征。以未接受过抗病毒治疗的HCC患者为参照，用多因素logistic回归，分析接受过抗病毒治疗的HCC患者的临床特征。 结果： 在2 590例乙型肝炎相关HCC患者中，接受过抗病毒治疗的患者占比仅为18.10%，而未接受过抗病毒治疗的患者中，有82.20%的患者符合治疗指征。接受过抗病毒治疗的HCC患者年龄更大（P < 0.05），肝硬化比例更高（P < 0.001），而血小板和丙氨酸转氨酶水平更低、肿瘤最大径更小（P < 0.001）。代谢性疾病方面，接受过抗病毒治疗的患者有更高的糖尿病（14.50%与7.70%，P < 0.001）、高血压（16.60%与11.20%，P < 0.05）、肥胖（28.50%与22.30%，P < 0.05）、超重（53.80%与43.50%，P < 0.001）及非酒精性脂肪性肝病（18.30%与8.00%，P < 0.001）患病率。在匹配其他差异临床特征后，接受过抗病毒治疗的患者其糖尿病，高血压，非酒精性脂肪性肝病的患病率仍高于未接受过抗病毒治疗的患者（14.50%与9.80%，P < 0.05；16.60%与10.20%，P < 0.05；18.30%与7.00%，P < 0.001）。多因素logistic回归分析结果显示，相比未接受过抗病毒治疗的HCC患者，接受过抗病毒治疗的HCC患者有更高的机会合并非酒精性脂肪性肝病（OR = 2.054，95% CI：1.404～3.004）。 结论： 在乙型肝炎相关HCC患者中，接受过抗病毒治疗的比例严重偏低（不足20%），提示抗病毒治疗的普及和推广任重道远。相比未接受过抗病毒治疗的HCC患者，接受过抗病毒治疗的HCC患者合并代谢性疾病的比例更高，需要高度重视代谢因素在乙型肝炎相关HCC致病过程中的作用。.
Keywords: Antiviral therapy; Hepatitis B; Hepatocellular carcinoma; Metabolic diseases.