潜伏性乙型肝炎是慢性丙型肝炎患者肝细胞癌的一个风险因素。
Latent hepatitis B is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C.
机构信息
Arvind Reddy, Elizabeth May, Murray Ehrinpreis, Milton Mutchnick, Division of Gastroenterology, Wayne State University, Detroit, MI 48201, United States.
出版信息
World J Gastroenterol. 2013 Dec 28;19(48):9328-33. doi: 10.3748/wjg.v19.i48.9328.
AIM
To study the potential association between hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC), cirrhosis and latent hepatitis B (LHB) infection, defined as the absence of detectable serum hepatitis B surface antigen (HBsAg) and the presence of hepatitis B core antibody (HBcAb).
METHODS
This retrospective analysis is comprised of 185 cirrhotic patients with HCC who were hepatitis C virus antibody (HCV Ab) (+) and HBsAg(-) at Wayne State University between 1999 and 2008. From these, 108 patients had HCV polymerase chain reaction confirmation of viremia while the remaining (77) were considered to have CHC on the basis of a positive HCV Ab and the absence of any other cause of liver disease. Controls were drawn from our institutional database from the same time period and consisted of 356 HBsAg(-) age, race and gender matched patients with HCV RNA-confirmed CHC and without evidence of HCC. A subgroup of controls included 118 matched patients with liver cirrhosis. χ² test and t test were used for data analysis.
RESULTS
Seventy-seven percent of patients in all 3 groups were African Americans. Patients with HCC had a significantly higher body mass index (P = 0.03), a higher rate of co-infection with human immunodeficiency virus (HIV) (P = 0.05) and a higher prevalence of alcohol abuse (P = 0.03) than the controls. More patients with HCC had LHB than controls (78% vs 39%, P = 0.01). Sixty three percent of patients with HCC were both hepatitis B surface antigen (HBsAb)(-) and HBcAb(+) compared to 23% of controls (P < 0.01). When compared to cirrhotic controls, the frequency of HBcAb(+) remained higher in patients with HCC (78% vs 45%, P = 0.02). Patients with HCC were more likely to be both HBsAb(-) and HBcAb(+) than the cirrhotic controls (63% vs 28%, P = 0.01). Although not statistically significant, 100% of CHC and HIV co-infected patients with HCC (n = 11) were HBcAb(+) when compared to controls (44%; n = 9).
CONCLUSION
These data suggest that LHB occurs at a significantly increased frequency in patients with CHC and HCC than in patients with CHC without HCC.
目的
研究慢性丙型肝炎（CHC）患者的肝细胞癌（HCC）、肝硬化与潜伏性乙型肝炎（LHB）感染之间的潜在关联，LHB 定义为血清乙型肝炎表面抗原（HBsAg）不可检测和乙型肝炎核心抗体（HBcAb）存在。
方法
这项回顾性分析包括 1999 年至 2008 年在韦恩州立大学的 185 例肝硬化 HCC 患者，这些患者丙型肝炎病毒抗体（HCV Ab）（+）且 HBsAg（-）。其中 108 例患者的 HCV 聚合酶链反应证实存在病毒血症，而其余 77 例患者根据 HCV Ab 阳性和无其他肝病病因被认为患有 CHC。对照组来自同一时期我们机构数据库，由 356 例年龄、种族和性别匹配的 HCV RNA 确认的 CHC 且无 HCC 证据的患者组成。对照组包括 118 例匹配的肝硬化患者。采用卡方检验和 t 检验进行数据分析。
结果
所有 3 组患者中 77%为非裔美国人。HCC 患者的体重指数（BMI）显著较高（P = 0.03），人类免疫缺陷病毒（HIV）合并感染率较高（P = 0.05），酒精滥用发生率较高（P = 0.03）。与对照组相比，更多的 HCC 患者有 LHB（78%比 39%，P = 0.01）。与对照组相比，HCC 患者 HBsAg（-）和 HBcAb（+）的比例更高（63%比 23%，P < 0.01）。与肝硬化对照组相比，HBcAb（+）在 HCC 患者中仍更为常见（78%比 45%，P = 0.02）。与肝硬化对照组相比，HBcAb（+）在 HCC 患者中更为常见（63%比 28%，P = 0.01）。虽然没有统计学意义，但与对照组（44%，n = 9）相比，100%的 CHC 和 HIV 合并感染 HCC 患者（n = 11）HBcAb（+）。
结论
这些数据表明，与无 HCC 的 CHC 患者相比，CHC 合并 HCC 患者的 LHB 发生率显著增加。
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