丙型肝炎病毒相关性肝硬化患者血清丙氨酸氨基转移酶水平升高与肝细胞癌更快发展及更高发病率之间的关联。

Association between high serum alanine aminotransferase levels and more rapid development and higher rate of incidence of hepatocellular carcinoma in patients with hepatitis C virus-associated cirrhosis.

作者信息

Tarao K, Rino Y, Ohkawa S, Shimizu A, Tamai S, Miyakawa K, Aoki H, Imada T, Shindo K, Okamoto N, Totsuka S

机构信息

Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan.

出版信息

Cancer. 1999 Aug 15;86(4):589-95. doi: 10.1002/(sici)1097-0142(19990815)86:4<589::aid-cncr7>3.0.co;2-k.

DOI:10.1002/(sici)1097-0142(19990815)86:4<589::aid-cncr7>3.0.co;2-k

PMID:10440686

Abstract

BACKGROUND

Many studies have demonstrated in animal experiments that persistent inflammation may accelerate the development of carcinoma. In this article, the question of whether the persistent elevation of serum alanine aminotransferase (ALT) levels (which represents the inflammatory necrosis of hepatocytes) correlates with the development of hepatocellular carcinoma (HCC) was studied in patients with early stage hepatitis C virus (HCV)-associated cirrhosis.

METHODS

Sixty-nine consecutive patients with biopsy proven HCV-associated cirrhosis (mostly Child's Stage A) who had been followed for >5 years for the development of HCC were studied. They were subdivided into 3 groups according to their serum ALT levels: Group A was comprised of 28 patients whose annual average serum ALT level was persistently high (>/= 80 IU) (high ALT group), Group B was comprised of 28 patients whose annual average serum ALT level was persistently low (< 80 IU) (low ALT group), and Group C was comprised of 13 unclassified patients. The patients had been studied prospectively with frequent ultrasonography and magnetic resonance imaging or computed tomography for > 5 years.

RESULTS

In the high ALT group HCC developed in 71.4% of patients compared with 25.0% in the low ALT group over the observation period (P < 0.005). The 5-year rate of incidence of HCC in the high ALT group was as high as 53.6% compared with only 7.1% in the low ALT group (P < 0.001). The expected interval between the diagnosis of cirrhosis and the development of HCC was 6.0 +/- 0.7 years (mean +/- standard error) in the high ALT group and 12.7 +/- 1.2 years in the low ALT group (P < 0.001).

CONCLUSIONS

The results of the current study demonstrated that the development of HCC was more rapid in the high ALT group with HCV-associated cirrhosis.

摘要

背景

许多研究已在动物实验中证明，持续性炎症可能加速癌症的发展。在本文中，我们研究了血清丙氨酸氨基转移酶（ALT）水平持续升高（代表肝细胞炎症性坏死）是否与早期丙型肝炎病毒（HCV）相关性肝硬化患者肝细胞癌（HCC）的发生相关这一问题。

方法

对69例经活检证实为HCV相关性肝硬化（大多为Child A期）且随访超过5年以观察HCC发生情况的连续患者进行了研究。根据血清ALT水平将他们分为3组：A组由28例年平均血清ALT水平持续较高（≥80 IU）的患者组成（高ALT组），B组由28例年平均血清ALT水平持续较低（<80 IU）的患者组成（低ALT组），C组由13例未分类患者组成。对这些患者进行了超过5年的前瞻性研究，频繁进行超声检查以及磁共振成像或计算机断层扫描。

结果

在观察期内，高ALT组71.4%的患者发生了HCC，而低ALT组为25.0%（P<0.005）。高ALT组HCC的5年发病率高达53.6%，而低ALT组仅为7.1%（P<0.001）。高ALT组从肝硬化诊断到HCC发生的预期间隔为6.0±0.7年（均值±标准误），低ALT组为12.7±1.2年（P<0.001）。