Xu Jing, Shi Jian, Wang Yi-Ping, Lin Yong, Chen Yue-Xiang, Lu Jian, Zeng Xin, Xie Wei-Fen
Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Med Sci Monit. 2009 Jun;15(6):CR274-9.
Serum HBeAg status and liver cirrhosis severity at the time of diagnosis of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-related cirrhosis remain inconclusive. The aim was to investigate the status of HBeAg and cirrhosis severity at the time of HCC development in the natural history of HBV-related cirrhosis in mainland China.
MATERIAL/METHODS: In a retrospective cross-sectional hospital-based setting, HBeAg status and severity of underlying cirrhosis, estimated by MELD (model for end-stage liver disease) scores and aspartate aminotransferase (AST)--to-platelet ratio index (APRI), were comprehensively compared in 377 HBsAg-positive compensated and decompensated liver cirrhosis and 434 with HCC patients to clarify the independent and joint effects of the factors.
The majority (80.6%) of the HCC patients was negative for serum HBeAg. More than two-thirds of the patients with HCC had MELD scores <10. Severity of underlying liver cirrhosis and loss of serum HBeAg independently correlated with the risk of HCC development. Compared with the contrast group of HBeAg-positive patients with MELD scores > or =20, the odds ratio of HCC development in the patients with HBeAg negativity and MELD score <10 was 26.51 (95%CI: 8.98-78.28).
A large proportion of HBV-related cirrhotic patients had negative serum HBeAg and mild cirrhosis severity at the time of diagnosis of HCC.
在乙型肝炎病毒（HBV）相关肝硬化患者中，肝细胞癌（HCC）诊断时血清HBeAg状态和肝硬化严重程度仍无定论。本研究旨在探讨中国大陆HBV相关肝硬化自然史中HCC发生时HBeAg状态及肝硬化严重程度。
材料/方法：在一项基于医院的回顾性横断面研究中，对377例HBsAg阳性的代偿期和失代偿期肝硬化患者及434例HCC患者的HBeAg状态和潜在肝硬化的严重程度进行了综合比较，潜在肝硬化严重程度通过终末期肝病模型（MELD）评分和天冬氨酸氨基转移酶（AST）-血小板比值指数（APRI）评估，以明确各因素的独立及联合作用。
大多数（80.6%）HCC患者血清HBeAg阴性。超过三分之二的HCC患者MELD评分<10。潜在肝硬化的严重程度和血清HBeAg阴性与HCC发生风险独立相关。与MELD评分≥20的HBeAg阳性患者对照组相比，HBeAg阴性且MELD评分<10的患者发生HCC的比值比为26.51（95%CI：8.98-78.28）。
很大一部分HBV相关肝硬化患者在HCC诊断时血清HBeAg阴性且肝硬化严重程度较轻。
