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1、肝细胞性肝癌伴癌综合征临床研究作者：杨明，肖亮，施晓敏作者单位：(1•解放军第181医院肝胆外科，广西桂林5410022上海长征医院肝移植科，上海200003)【摘要】目的研究肝细胞性肝癌(hepatocellularcarcinoma,HCC)患者伴癌综合征(paraneoplasticsyndromes,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
2、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)o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(PvO.05),而生存时间较短(P<0.01)oCox多因素冋归分析显示AFP>800ng/ml,肿瘤直径>6.5cm和PNS的发生显著相关(P<0.05)o结论伴PNS的HCC患者预后
3、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。【关键词】癌，肝细胞，伴癌综合征，治疗，临床研究性ClinicalresearchonparaneoplasticsyndromesinpatientswithhepatocellularcarcinomaYANGMing,XIAOLiang,SHIXiaomin.*DepartmentofLiverTransplantation,ChangzhengHospital,Shanghai200003AbstractObjectiveToin
4、vestigatetheclinicalcharacteristicsofparaneoplasticsyndromes(PNS)ofhepatocellularcarcinoma(HCC).MethodsTheclinicaldataof360PHCpatientswerereviewedretrospectively.ResultsAmongthepatientswithHCC,17.8%(64/360)hadPNS,themale?卿to?郵femaleratiowas7：1.PNSmainlymanifest
5、edassixclinicalabnormalities：hypoglycemia(9.2%),hypercholesterolemia(5.6%),leucocytosis(5.0%),thrombocytosis(3.3%),erythrocytosis(2.8%)andhypercalcemia(1.7%).Comparedwiththenon?WPNSpatients,thePNSpatientsshowedstatisticaldifferencesinthelevelsofserumAFP,tumorsi
6、ze,incidenceofportalveinthromobosis,hepaticvirusBinfectionandserumglutamyltranspeptidase(P<0.05).However,thesurvivaltimewasrelativelyshorter(P<0.01).SerumAFPhigherthan800ng/mlandtumordiametergreaterthan6.5cmwerefoundtobepredictorsforPNSusingCoxproportionalhazar
7、dsregressionmodel(P<0.05).ConclusionTheclinicalmanifestationsofPNSarenonspecific,whichmakesiteasytomisdiagnosed.Inordertomakeearlydiagnosis,treatmentandimprovetheprognosis,itissignificanttogetmoreknowledgeofPNS・Keywordscarcinoma,hepatocellular;paraneoplasticsyn
8、drome;therapies,investigational肝细胞性肝癌(hepatocellularcarcinoma,HCC)患者常发工伴癌综合征(paraneoplasticsyndrome,PNS),使其临床表现更为复朵，治疗更棘手。而由于重视不够，临床上对PNS常有漏诊。止确认识PNS的临床、生化、与病理特征，对PHC的早期诊治有重
