| Objective:To clarify the relation between Hepatitis B surface antigen and HBV-DNA with different levels of serum HBsAg positive patients and the risk of primary liver cancer.Furthermore,HBsAg alone or in combination with HBV-DNA can be used to quantitatively predict the risk of primary liver cancer.Methods:Two hundreds of HBsAg-associated liver cancer patients admitted to the First Affiliated Hospital of Nanchang university on January 1,2008 to December 31,2018 were selected as the study subjects,and 200 cases of HBsAg-positive patients with roughly matched age and gender were also selected as the study subjects in the outpatient department of infectious diseases of the same period.Clinical data were collected,including laboratory examination,imaging and pathological examination data.According to the case-control study method,factors that might confuse the results of the study were screened,and the confounding factors included patients'gender,age,family members'history of liver cancer,smoking or drinking,hepatitis b,HBV-DNA level,and the presence of hypertension,diabetes and other diseases.SPSS 19.0 was used for statistical analysis of all research data,and chi-square test or Student's t test was used to compare the differences between the two groups.After univariate and multivariate Logistic regression analysis,OR value and 95%confidence interval(CI)of related factors were obtained,and P value<0.05 was statistically significant.Results:1.Univariate Logistic regression analysis found that the risk factors for liver cancer in patients with serum HBsAg positivity included smoking,alcohol consumption,type 2 diabetes,family history of liver cancer,HBeAg positivity,HBsAg and HBV-DNA.2.Multivariate Logistic regression analysis found that the risk factors for primary liver cancer in patients with serum HBsAg positive include:alcohol consumption(OR 2.53,95%CI:1.60-4.01),family history of liver cancer(OR 3.07,95%CI:1.44-6.51),HBeAg positive(OR 2.07,95%CI:1.32-2.23),HBsAg(100-999IU/mL:OR 1.88,95%CI:0.94-3.77;1000-9999IU/mL:OR 3.30,95%CI:1.70-6.37;?10000IU/mL:OR 3.66,95%CI:1.48-6.78)and HBV-DNA(10~3-10~5:OR 1.64,95%CI:0.99-2.70);>10~5IU/mL:3.46,95%CI:2.03-5.88).3.Stratified analysis of HBV-DNA levels showed that HBsAg positive patients with HBV-DNA<10~3IU/mL and serum HBsAg?100IU/mL had a 39%increased risk of primary liver cancer(OR 1.39,95%CI:0.99-1.78),while HBsAg positive patients with HBV-DNA?10~3IU/mL and serum HBsAg?100IU/mL had a 74%increased risk of primary liver cancer(OR 1.74,95%CI:1.31-2.26).4.Stratified analysis combining HBsAg and HBV-DNA at minimum OR maximum levels found that HBsAg<100IU/mL and HBV-DNA<10~3IU/mL levels in serum HBsAg positive patients reduced the risk of primary liver cancer by 57%compared with other serum HBsAg positive patients(OR 0.43,95%CI:HBsAg positive patients with serum HBsAg?10000IU/mL and HBV-DNA>10~5IU/mL were4.10 times more likely to develop primary liver cancer than other HBsAg positive serum patients(OR 4.10,95%CI:1.86-9.06).Conclusions:Alcohol consumption,family history of liver cancer,HBeAg,HBV-DNA and HBsAg levels were identified as independent risk factors for liver cancer in serum HBsAg positive patients.We found that the increase of quantitative indexes of HBsAg and HBV-DNA alone or in combination showed a dose-response relationship with the risk of primary liver cancer.In the risk prediction of primary liver cancer,HBsAg level may be complementary to HBV-DNA level,and the combination of HBsAg and HBV-DNA level is more helpful for clinical physician to predict the risk of liver cancer in patients with serum HBsAg positive. |
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