Horie Yoshinori, Yamagishi Yoshiyuki, Kajihara Mikio, Kato Shinzo, Ishii Hiromasa
Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
Alcohol Clin Exp Res. 2003 Aug;27(8 Suppl):32S-36S. doi: 10.1097/01.ALC.0000078605.33391.20.
The major cause of hepatocellular carcinoma (HCC) in the general Japanese population is an infection related to hepatotropic viruses, especially hepatitis virus C (HCV). Even in heavy drinkers, the major cause of HCC is HCV infection. However, HCC without viral infection has been reported in heavy drinkers. Alcohol has been also reported to be associated with an increased risk of cancer. In this study, we investigated aspects of HCC pathogenesis in heavy drinkers in Japan.
Questionnaires were sent to 1,350 hospitals authorized by the Japanese Society of Gastroenterology. The questionnaires asked about the number of inpatients with the different types of alcoholic liver diseases, admitted to each hospital between 1998 and 2001.
The percentage of heavy drinkers among all admitted patients with liver diseases or liver cirrhosis was approximately 15%. Of the patients with alcoholic liver cirrhosis, the cirrhosis was derived from alcohol alone in 61% and from alcohol plus a virus in 39% of patients. Furthermore, the percentage of patients with alcoholic liver cirrhosis caused by alcohol alone and who did not have HCC was 80%. However, the percentage of HCC patients who tested negative for viral hepatitis serum markers was 27% of the total number of heavy drinkers admitted for HCC. A study mainly on liver cirrhosis performed in the early 1990's demonstrated that the alcohol-alone group accounted for 44% of admitted patients with alcoholic liver cirrhosis and 18% of heavy drinkers admitted for HCC.
Because the consumption of alcohol is increasing in Japan, the frequency and number of cases of alcoholic liver cirrhosis are increasing. Viral hepatitis infection, however, still plays an important role in hepatocarcinogenesis in heavy drinkers. Radiographical examination is recommended even in patients with alcoholic liver cirrhosis who test negative for serum markers of viral hepatitis.
在日本普通人群中，肝细胞癌（HCC）的主要病因是与嗜肝病毒相关的感染，尤其是丙型肝炎病毒（HCV）。即使在重度饮酒者中，HCC的主要病因也是HCV感染。然而，已有报道称重度饮酒者中存在无病毒感染的HCC。酒精也被报道与癌症风险增加有关。在本研究中，我们调查了日本重度饮酒者中HCC发病机制的相关方面。
向日本胃肠病学会授权的1350家医院发送问卷。问卷询问了1998年至2001年间各医院收治的不同类型酒精性肝病住院患者的数量。
在所有肝病或肝硬化住院患者中，重度饮酒者的比例约为15%。在酒精性肝硬化患者中，仅由酒精引起肝硬化的患者占61%，由酒精加病毒引起肝硬化的患者占39%。此外，仅由酒精引起且无HCC的酒精性肝硬化患者比例为80%。然而，在因HCC入院的重度饮酒者总数中，病毒型肝炎血清标志物检测呈阴性的HCC患者比例为27%。一项主要针对20世纪90年代初肝硬化患者的研究表明，仅酒精组占酒精性肝硬化住院患者的44%，占因HCC入院的重度饮酒者的18%。
由于日本酒精消费量在增加，酒精性肝硬化的发病率和病例数也在增加。然而，病毒型肝炎感染在重度饮酒者的肝癌发生中仍起着重要作用。即使是病毒型肝炎血清标志物检测呈阴性的酒精性肝硬化患者，也建议进行影像学检查。
