【摘要】 目的研究肝细胞性肝癌(hepatocellular carcinoma,HCC)患者伴癌综合征(paraneoplastic syndromes,PNS)的发病率和临床意义。方法回顾性分析360例HCC患者的生化、影像和病理检查结果,比较PNS组与非PNS组的差异。结果PNS占同期HCC患者住院人数的17.8%(64/360),男女之比为7∶1。PNS主要表现为:低血糖症(占同期HCC患者的9.2%,下同),高胆固醇血症(5.6%),白细胞增多症(5.0%),血小板增多症(3.3%),红细胞增多症(2.8%),高钙血症(1.7%),有两种或两种以上表现者为6.9%(25/360)。与非PNS组相比,PNS组患者的AFP水平、肿瘤直径、门脉癌栓发生率、乙肝病毒感染率和GGT水平显著较高(P<0.05),而生存时间较短(P<0.01)。Cox多因素回归分析显示AFP>800 ng/ml,肿瘤直径>6.5 cm和PNS的发生显著相关(P<0.05)。结论伴PNS的HCC患者预后较差,PNS的发生与AFP水平,肿瘤直径密切相关,熟悉其临床特征有助于早期诊治。更多还原

【Abstract】 Objective To investigate the clinical characteristics of paraneoplastic syndromes(PNS) of hepato-cellular carcinoma(HCC).Methods The clinical data of 360 PHC patients were reviewed retrospectively.Re-sults Among the patients with HCC,17.8%(64/360) had PNS,the male-to-female ratio was 7∶1.PNS mainly manifested as six clinical abnormalities: hypoglycemia(9.2%),hypercholesterolemia(5.6%),leucocytosis(5.0%),thrombocytosis(3.3%),erythrocytosis(2.8%) and hypercalcemia(1.7%).Compared with the non-PNS patients,the PNS patients showed statistical differences in the levels of serum AFP,tumor size,incidence of portal vein thromobosis,hepatic virus B infection and serum glutamyltranspeptidase(P<0.05).However,the survival time was relatively shorter(P<0.01).Serum AFP higher than 800 ng/ml and tumor diameter greater than 6.5 cm were found to be predictors for PNS using Cox proportional hazards regression model(P<0.05).Conclusion The clinical manifestations of PNS are nonspecific,which makes it easy to misdiagnosed.In order to make early diagnosis,treatment and improve the prognosis,it is significant to get more knowledge of PNS.更多还原