Coursaget P, Yvonnet B, Barres J L, Perrin J, Tortey E, Diop B, Kocheleff P, Duflo B, M'Boup S, Diop-Mar I
Rev Epidemiol Sante Publique. 1985;33(4-5):267-75.
During the past 15 years, a growing body of evidence incriminates hepatitis B virus as the major factor in the etiology of primary liver cancer. Epidemiological studies throughout the world reported a striking correspondence between areas where the frequency of primary liver cancer is high and where HBV infection is hyperendemic. Moreover, primary liver cancer is commonly associated with cirrhosis of the postnecrotic macronodular type. Such data suggested a sequence hepatitis-cirrhosis-PLC. Such sequence was confirmed by extensive serologic testing studies which reported a high frequency of HBV markers in PLC patients compared to matched control groups. Data collected in Senegal, Mali and Burundi on 12,000 individuals stress the importance of HBV infections in these countries, as the high rate of chronic carrier state in patients suffering from liver cirrhosis or primary liver cancer (62-63%) compared to the general population (12-17%). Other HBV markers including anti-HBs, anti-HBc, HBeAg and anti-HBe had no prognostic value in the sequence hepatitis-cirrhosis-PLC. A new HBV seric marker, the HBsAg/IgM complexes, observed in HBsAg positive individuals, is more frequently detected in PLC patients (50%) and cirrhosis (40%) than in healthy HBsAg carriers (14%). These results would indicate that HBsAg carriers are more likely to develop cirrhosis or primary liver cancer when they evidence HBsAg/IgM complexes. In conclusion, the seric markers of evolution towards primary liver cancer are: HBsAg (the highest known risk factor), the presence in such individuals of HBsAg/IgM complexes, and increased values of alphafoetoprotein.
在过去15年中，越来越多的证据表明乙型肝炎病毒是原发性肝癌病因中的主要因素。世界各地的流行病学研究报告称，原发性肝癌高发地区与乙肝病毒感染高度流行地区之间存在显著对应关系。此外，原发性肝癌通常与坏死后大结节型肝硬化相关。这些数据提示了肝炎-肝硬化-原发性肝癌的发病顺序。广泛的血清学检测研究证实了这一顺序，该研究报告称，与配对对照组相比，原发性肝癌患者中乙肝病毒标志物的出现频率很高。在塞内加尔、马里和布隆迪对12000人收集的数据强调了乙肝病毒感染在这些国家的重要性，因为肝硬化或原发性肝癌患者的慢性携带者状态发生率（62%-63%）高于普通人群（12%-17%）。其他乙肝病毒标志物，包括抗-HBs、抗-HBc、HBeAg和抗-HBe，在肝炎-肝硬化-原发性肝癌的发病顺序中没有预后价值。在乙肝表面抗原阳性个体中观察到的一种新的乙肝病毒血清标志物，即乙肝表面抗原/IgM复合物，在原发性肝癌患者（50%）和肝硬化患者（40%）中比在健康的乙肝表面抗原携带者（14%）中更频繁地被检测到。这些结果表明，当乙肝表面抗原携带者出现乙肝表面抗原/IgM复合物时，他们更有可能发展为肝硬化或原发性肝癌。总之，原发性肝癌进展的血清标志物为：乙肝表面抗原（已知最高风险因素）、此类个体中乙肝表面抗原/IgM复合物的存在以及甲胎蛋白值升高。
