目的:肝细胞腺瘤(HCA)出血的已知危险因素是大小>5cm,增长率,可见的血管,外生性病变,β-连环蛋白和SonicHedgehog激活HCA。大多数研究基于欧洲队列。这项研究的目的是确定美国队列中HCA出血的其他危险因素。
方法:回顾性图表回顾了在某学术大专院校的磁共振成像诊断为HCA的患者(n=184)。临床,病态,并收集影像学资料。测量的主要结果是HCA出血和恶性肿瘤。使用卡方对SAS9.4进行统计分析,费希尔的精确检验,样本t检验,非参数Wilcoxon检验,和逻辑回归。
结果:排除病理显示局灶性结节增生和非腺瘤病变的患者后,有167例患者的随访数据.16%出现显微镜或肉眼出血,1.2%出现恶性肿瘤。HCA大小可预测出血(P<0.0001),无病灶大小<1.8cm的患者出血。在未经调整的分析中,肝腺瘤病(≥10个病灶)出血风险增加2.8倍.单个病变出血的患者,77%的血液从>5cm的病变处流出。在有多个HCA出血的患者中,50%的血从病变<5cm处流出。在多发性腺瘤患者中,大小(P=.001)独立预测出血和肝脂肪变性倾向于增加出血风险(P=.05)。
结论:在一个庞大的美国队列中,大小预测HCA出血风险增加,而肝腺瘤病则有出血风险增加的趋势.在患有多种HCA的患者中,大小预测出血和肝脏脂肪变性倾向于增加出血风险。
OBJECTIVE: Known risk factors for hepatocellular adenoma (HCA) bleeding are size >5 cm, growth rate, visible vascularity, exophytic lesions, β-catenin and Sonic Hedgehog activated HCAs. Most studies are based on European cohorts. The objective of this study is to identify additional risk factors for HCA bleeding in a US cohort.
METHODS: Retrospective chart review was performed on patients diagnosed with HCA on magnetic resonance imaging (n = 184) at an academic tertiary institution. Clinical, pathological, and imaging data were collected. Primary outcomes measured were HCA bleeding and malignancy. Statistical analysis was performed with SAS 9.4 using Chi-Square, Fisher\'s exact test, sample t test, non-parametric Wilcoxon test, and logistic regression.
RESULTS: After excluding patients whose pathology showed focal nodular hyperplasia and non-adenoma lesions, follow-up data were available for 167 patients. 16% experienced microscopic or macroscopic bleeding and 1.2% had malignancy. HCA size predicted bleeding (P < .0001) and no patients with lesion size <1.8 cm bled. In unadjusted analysis, hepatic adenomatosis (≥10 lesions) trended towards 2.8-fold increased risk of bleeding. Of patients with a single lesion that bled, 77% bled from a lesion >5 cm. In patients with multiple HCAs that bled, 50% bled from lesions <5 cm. In patients with multiple adenomas, size (P = .001) independently predicted bleeding and hepatic steatosis trended towards increased risk of bleeding (P = .05).
CONCLUSIONS: In a large US cohort, size predicted increased risk of HCA bleeding while hepatic adenomatosis trended towards increased risk of bleeding. In patients with multiple HCAs, size predicted bleeding and hepatic steatosis trended toward increased risk of bleeding.