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肝吸虫相关胆道癌。

Liver Fluke-Associated Biliary Tract Cancer.

机构信息

Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand.

出版信息

Gut Liver. 2018 May 15;12(3):236-245. doi: 10.5009/gnl17102.

Abstract

Cholangiocarcinoma (CCA) is an aggressive cancer arising from epithelial cells of the bile duct. Most patients with CCA have an unresectable tumor at the time of diagnosis. In Western countries, the risk of CCA increases in patients with primary sclerosing cholangitis, whereas liver fluke infection appears to be the major risk factor for CCA in Asian countries. A diagnosis of liver fluke infection often relies on stool samples, including microscopic examination, polymerase chain reaction-based assays, and fluke antigen detection. Tests of serum, saliva and urine samples are also potentially diagnostic. The presence of liver fluke along with exogenous carcinogens magnifies the risk of CCA in people living in endemic areas. The "liver fluke-cholangiocarcinoma" carcinogenesis pathways consist of mechanical damage to the bile duct epithelium, immunopathologic and cellular reactions to the liver fluke's antigens and excretory/secretory products, liver fluke-induced changes in the biliary tract microbiome and the effects of repeated treatment for liver fluke. A vaccine and novel biomarkers are needed for the primary and secondary prevention of CCA in endemic areas. Importantly, climate change exerts an effect on vector-borne parasitic diseases, and awareness of liver fluke should be enhanced in potentially migrated habitat areas.

摘要

胆管癌(CCA)是一种起源于胆管上皮细胞的侵袭性癌症。大多数 CCA 患者在诊断时已患有不可切除的肿瘤。在西方国家,原发性硬化性胆管炎患者发生 CCA 的风险增加,而肝吸虫感染似乎是亚洲国家 CCA 的主要危险因素。肝吸虫感染的诊断通常依赖于粪便样本,包括显微镜检查、聚合酶链反应检测和肝吸虫抗原检测。血清、唾液和尿液样本的检测也具有潜在的诊断价值。在流行地区生活的人群中,肝吸虫和外源性致癌物质的存在会增加 CCA 的风险。“肝吸虫-胆管癌”的发生途径包括胆管上皮的机械损伤、对肝吸虫抗原和分泌/排泄产物的免疫病理和细胞反应、肝吸虫诱导的胆道微生物组变化以及反复治疗肝吸虫的影响。在流行地区,需要疫苗和新型生物标志物来进行 CCA 的一级和二级预防。重要的是,气候变化对虫媒寄生虫病产生影响,应在潜在迁移的栖息地地区提高对肝吸虫的认识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b03/5945254/bdb61575cde3/gnl-12-236f1.jpg

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