Adachi Shigeru, Shibuya Akitaka, Miura Yukiko, Takeuchi Atsuko, Nakazawa Takahide, Saigenji Katsunori
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Scand J Gastroenterol. 2008;43(7):849-56. doi: 10.1080/00365520801935459.
Although hepatitis B virus (HBV) DNA can be detected in liver or sera of patients without serum hepatitis B surface antigen (HBsAg), its clinical relevance in hepatocarcinogenesis remains controversial. This observational cohort study was conducted to clarify the risk factors, including the presence of serum HBV DNA and hepatitis B core antibody (anti-HBc), for hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related liver cirrhosis (LC).
The study comprised 123 patients with LC due to HCV, and negative for HBsAg. The risk factors for HCC development were analyzed by univariate and multivariate analysis. Serum samples were assayed for HBV DNA using real-time polymerase chain reaction.
Serum HBV DNA was detectable in 14 patients (11.4%) and serum anti-HBc in 96 (78.0%). During the follow-up period (mean 53.3 months), 80 patients (65.0%) developed HCC. The cumulative HCC development rate was significantly higher in the anti-HBc-positive group than in the anti-HBc-negative group (p=0.0039), but did not differ between the serum HBV DNA-positive and -negative groups (p=0.8570). The multivariate analysis indicated that male gender, alpha-fetoprotein (AFP) 20 ng/ml or greater, average serum alanine aminotransferase (ALAT) 80 IU/l or greater and the presence of anti-HBc were independent risk factors for development of HCC (p=0.038, p=0.013, p=0.020 and p=0.001, respectively).
Serum anti-HBc, which indicates a previous HBV infection, has clinical significance in hepatocarcinogenesis in patients with HCV-related LC, but serum HBV DNA does not. Therefore, anti-HBc in serum is a significant predictor for HCC.
尽管在无血清乙肝表面抗原（HBsAg）的患者肝脏或血清中可检测到乙肝病毒（HBV）DNA，但其在肝癌发生中的临床相关性仍存在争议。本观察性队列研究旨在阐明丙型肝炎病毒（HCV）相关肝硬化（LC）患者发生肝细胞癌（HCC）的危险因素，包括血清HBV DNA和乙肝核心抗体（抗-HBc）的存在情况。
本研究纳入123例因HCV导致LC且HBsAg阴性的患者。通过单因素和多因素分析来分析HCC发生的危险因素。采用实时聚合酶链反应检测血清样本中的HBV DNA。
14例患者（11.4%）血清可检测到HBV DNA，96例（78.0%）血清可检测到抗-HBc。在随访期（平均53.3个月），80例患者（65.0%）发生了HCC。抗-HBc阳性组的累积HCC发生率显著高于抗-HBc阴性组（p=0.0039），但血清HBV DNA阳性组和阴性组之间无差异（p=0.8570）。多因素分析表明，男性、甲胎蛋白（AFP）≥20 ng/ml、平均血清丙氨酸氨基转移酶（ALAT）≥80 IU/l以及抗-HBc的存在是HCC发生的独立危险因素（分别为p=0.038、p=0.013、p=0.020和p=0.001）。
表明既往HBV感染的血清抗-HBc在HCV相关LC患者的肝癌发生中具有临床意义，但血清HBV DNA无此意义。因此，血清抗-HBc是HCC的重要预测指标。
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