Mizrak Dilşa, Engin Başak, Onder Fatih Oğuz, Yener Burcu, Bektaş Mehmet, Biyikli Zeynep, Idilman Ramazan, Cinar Kubilay, Karayalçin Kaan, Ersöz Sadik, Karayalçin Selim, Ozden Ali, Yurdaydin Cihan, Yazihan Nuray, Ataoğlu Haluk, Bozkaya Hakan, Uzunalimoğlu Ozden
Departments of Internal Medicine, Ankara University, School of Medicine, Ankara.
Turk J Gastroenterol. 2009 Sep;20(3):192-7. doi: 10.4318/tjg.2009.0006.
BACKGROUND/AIMS: Hepatocellular carcinoma is the fifth most common cancer and a major public health problem worldwide. Differences in distribution of hepatocellular carcinoma incidence are probably due to different levels of exposure to hepatocellular carcinoma risk factors: chronic infections with hepatitis B virus (HBV) and aflatoxin exposure in developing countries, and smoking and alcohol abuse in developed countries. Aflatoxin is one of the most important of the environmental toxins that contribute to the pathogenesis of hepatocellular carcinoma, especially in the regions where dietary foodstuffs (peanuts, corn, Brazil nuts, pistachios, spices and figs) are highly contaminated. High aflatoxin levels have been shown in the foodstuffs that are produced in our country. The specific aim of this study was to assess the rate of aflatoxin exposure and to determine some clues about aflatoxin metabolism by measuring and comparing the levels of carcinogenic forms in healthy subjects, in different stages of viral disease, and in different viral hepatitis types.
This was a cross-sectional observational, single-center study. A total of 203 (male/female: 119/84) viral hepatitis patients who were consecutively admitted to Ankara University, School of Medicine, Gastroenterology Clinic, between January 2006 and June 2007 were enrolled into the study. Sixty-two healthy subjects (male/female: 33/29) with normal blood chemistry and negative viral serology served as controls. Chemical forms AFB1, AFB2, AFG1, and AFG2 were assessed in plasma of study participants by high-performance liquid chromatography.
AFB1, AFB2, AFG1, and AFG2 were detected in 24.6%, 17.2%, 22.7%, 18.2% of the 203 patients, respectively, and were significantly higher than in the control group for all chemical forms. Percentage of AFB1-positive patients was significantly higher than in the control group irrespective of disease stage. There was no significant difference between chronic infected patients, cirrhotic patients and patients with Hepatocellular carcinoma with respect to percentage of aflatoxin-positive individuals.
With this study, we have documented that in viral hepatitis patients, aflatoxin exposure is significantly higher than in healthy subjects in Turkey and it may play an important role in the development of hepatocellular carcinoma. Thus, large studies exploring the relation between aflatoxin exposure, viral hepatitis status, and risk of hepatocellular carcinoma development are needed.
背景/目的：肝细胞癌是全球第五大常见癌症，也是一个重大的公共卫生问题。肝细胞癌发病率分布的差异可能归因于对肝细胞癌风险因素的不同暴露水平：发展中国家的乙型肝炎病毒（HBV）慢性感染和黄曲霉毒素暴露，以及发达国家的吸烟和酗酒。黄曲霉毒素是导致肝细胞癌发病机制的最重要环境毒素之一，特别是在膳食食品（花生、玉米、巴西坚果、开心果、香料和无花果）高度污染的地区。我国生产的食品中已显示出高黄曲霉毒素水平。本研究的具体目的是通过测量和比较健康受试者、不同病毒疾病阶段以及不同病毒性肝炎类型中致癌形式的水平，评估黄曲霉毒素暴露率并确定一些有关黄曲霉毒素代谢的线索。
这是一项横断面观察性单中心研究。2006年1月至2007年6月期间连续入住安卡拉大学医学院胃肠病学诊所的203例（男/女：119/84）病毒性肝炎患者被纳入研究。62名血液生化正常且病毒血清学阴性的健康受试者（男/女：33/29）作为对照。通过高效液相色谱法评估研究参与者血浆中的化学形式AFB1、AFB2、AFG1和AFG2。
在203例患者中，AFB1、AFB2、AFG1和AFG2的检测率分别为24.6%、17.2%、22.7%、18.2%，所有化学形式均显著高于对照组。无论疾病阶段如何，AFB1阳性患者的百分比均显著高于对照组。黄曲霉毒素阳性个体的百分比在慢性感染患者、肝硬化患者和肝细胞癌患者之间无显著差异。
通过本研究，我们记录了在土耳其，病毒性肝炎患者的黄曲霉毒素暴露显著高于健康受试者，并且它可能在肝细胞癌的发生中起重要作用。因此，需要进行大规模研究来探索黄曲霉毒素暴露、病毒性肝炎状态与肝细胞癌发生风险之间的关系。
