Zampino Rosa, Pisaturo Maria A, Cirillo Grazia, Marrone Aldo, Macera Margherita, Rinaldi Luca, Stanzione Maria, Durante-Mangoni Emanuele, Gentile Ivan, Sagnelli Evangelista, Signoriello Giuseppe, Miraglia Del Giudice Emanuele, Adinolfi Luigi E, Coppola Nicola
Internal Medicine and Hepatology, Department of Clinical Medicine and Surgery-University of Naples Federico.
Department of Mental Health and Public Medicine, Section of Infectious Diseases, Department of Clinical Medicine and Surgery-University of Naples Federico.
Ann Hepatol. 2015 Jan-Feb;14(1):75-82.
Hepatocellular carcinoma (HCC) is a development of severe liver disease frequently due to HBV and/or HCV infection. The aim of this retrospective study was to evaluate the development of HCC in patients with HBV-HCV chronic infection compared with patients with single HBV or HCV infection and the viral and host factors correlated to HCC in co-infected patients. We studied 268 patients with histology proven chronic hepatitis: 56 had HBV-HCV co-infection (HBV-HCV group), 46 had HBV infection (HBV group) and 166 had HCV infection (HCV group). Patients were followed up for at least 3 years. Viral and host factors were studied. HCC was more frequent in HBV-HCV group (14%) compared with HBV (2%, p = 0.006) and HCV monoinfected (4%, p = 0.006). The Mantel-Haenszel test used to investigate the relationship between HBV-HCV co-infection and development of HCC indicated an association between development of HCC and HBV-HCV co-infection (p < 0.001). In the HBV-HCV group, patients with HCC were significantly older (p = 0.000), had longer disease duration (p = 0.001), higher blood glucose levels (p = 0.001), lower levels of steatosis (p = 0.02), higher levels of fibrosis (p = 0.000), higher HCV RNA (p = 0.01) than those without HCC. ALT, lipid profile, PNPLA3 variant distribution and HBV viral load did not differ among co-infected patients with or without HCC. In conclusion HCC was more frequent in our patients with HBV-HCV co-infection, than in those with HBV or HCV mono-infection; possible associated risk factors for HCC development seem a long duration of disease, high levels of fibrosis and carbohydrate intolerance.
肝细胞癌（HCC）通常是由乙肝病毒（HBV）和/或丙肝病毒（HCV）感染导致的严重肝脏疾病的一种进展形式。本回顾性研究的目的是评估HBV-HCV慢性感染患者与单一HBV或HCV感染患者中HCC的发生情况，以及合并感染患者中与HCC相关的病毒和宿主因素。我们研究了268例经组织学证实的慢性肝炎患者：56例为HBV-HCV合并感染（HBV-HCV组），46例为HBV感染（HBV组），166例为HCV感染（HCV组）。对患者进行了至少3年的随访。研究了病毒和宿主因素。与HBV组（2%，p = 0.006）和HCV单感染组（4%，p = 0.006）相比，HBV-HCV组中HCC更为常见（14%）。用于研究HBV-HCV合并感染与HCC发生之间关系的Mantel-Haenszel检验表明，HCC的发生与HBV-HCV合并感染之间存在关联（p < 0.001）。在HBV-HCV组中，发生HCC的患者年龄显著更大（p = 0.000），病程更长（p = 0.001），血糖水平更高（p = 0.001），脂肪变性水平更低（p = 0.02），纤维化水平更高（p = 0.000），HCV RNA水平更高（p = 0.01），高于未发生HCC的患者。在合并感染的患者中，无论有无HCC，丙氨酸转氨酶（ALT）、血脂谱、帕他汀样磷脂酶域包含蛋白3（PNPLA3）变体分布和HBV病毒载量均无差异。总之，在我们的患者中，HBV-HCV合并感染患者的HCC发生率高于HBV或HCV单感染患者；HCC发生的可能相关危险因素似乎是病程长、纤维化水平高和碳水化合物不耐受。
