Bahri Olfa, Ezzikouri Sayeh, Alaya-Bouafif Nissaf Ben, Iguer Fella, Feydi Abdallah Essaid El, Mestiri Hafedh, Benazzouz Moustapha, Khalfallah Tahar, Afifi Rajaa, Elkihal Latifa, Berkane Salah, Marchio Agnes, Debzi Nabil, Dejean Anne, Pineau Pascal, Triki Hinda, Benjelloun Soumaya
Olfa Bahri, Hinda Triki, Laboratory of Clinical Virology, Institut Pasteur of Tunis, Tunis, BP 1002, Tunisia.
World J Hepatol. 2011 Jan 27;3(1):24-30. doi: 10.4254/wjh.v3.i1.24.
To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa.
A multicenter case control study was conducted in Tunisia, Morocco and Algeria in collaboration with Pasteur Institutes in these countries. A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included. Prevalences of HBsAg, anti-hepatitis C virus (HCV) and diabetes were assessed. HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients.
The mean age of patients was 62 ± 10 years old for a 1.5 M:F sex ratio. Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg. Diabetes was detected in 18% of cases. Odd ratio (OR) and 95% confidence intervals (CI) were 32.0 (15.8 - 65.0), 7.2 (3.2 - 16.1) and 8.0 (3.1 - 20.0) for anti-HCV, HBsAg and diabetes respectively. Multivariate analysis indicated that the three studied factors were independent. 1b HCV genotype and D HBV genotype were predominant in HCC patients. HCV was the only risk factor significantly associated with an excess of cirrhosis (90% vs 68% for all other risk factors collectively, P = 0.00168). Excessive alcohol consumption was reliably established for 19 (17.6%) cases among the 108 HCC patients for whom data is available.
HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa. An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.
评估北非西部地区肝细胞癌（HCC）发生的主要危险因素的作用。
与这些国家的巴斯德研究所合作，在突尼斯、摩洛哥和阿尔及利亚开展了一项多中心病例对照研究。共纳入164例HCC患者和250例无肝脏疾病的对照者。评估乙肝表面抗原（HBsAg）、抗丙型肝炎病毒（HCV）和糖尿病的患病率。对HCV抗体和HBsAg阳性患者进行HCV和HBV基因分型。
患者的平均年龄为62±10岁，男女比例为1.5:1。60%的HCC患者抗HCV阳性，17.9%的患者HBsAg阳性。18%的病例检测到糖尿病。抗HCV、HBsAg和糖尿病的比值比（OR）及95%置信区间（CI）分别为32.0（15.8 - 65.0）、7.2（3.2 - 16.1）和8.0（3.1 - 20.0）。多因素分析表明，所研究的三个因素相互独立。1b型HCV基因型和D型HBV基因型在HCC患者中占主导地位。HCV是与肝硬化过度发生显著相关的唯一危险因素（90%对所有其他危险因素合计的68%，P = 0.00168）。在有数据的108例HCC患者中，有19例（17.6%）确实存在过量饮酒。
HCV和HBV感染以及糖尿病是北非HCC发生的主要决定因素。对慢性肝炎患者和营养相关代谢性肝病患者开展积极监测和二级预防项目是降低该地区HCC风险的最重要措施。
