抗丙型肝炎病毒呈阳性的超声粗结节性肝硬化患者发生肝细胞癌的风险很高。

Patients with ultrasonic coarse-nodular cirrhosis who are anti-hepatitis C virus-positive are at high risk for hepatocellular carcinoma.

作者信息

Tarao K, Hoshino H, Shimizu A, Ohkawa S, Harada M, Nakamura Y, Ito Y, Tamai S, Okamoto N

机构信息

Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan.

出版信息

Cancer. 1995 Mar 15;75(6):1255-62. doi: 10.1002/1097-0142(19950315)75:6<1255::aid-cncr2820750607>3.0.co;2-q.

DOI:10.1002/1097-0142(19950315)75:6<1255::aid-cncr2820750607>3.0.co;2-q

PMID:7533653

Abstract

BACKGROUND

The relationship between echosonographic patterns of patients with cirrhosis who are antihepatitis C virus (HCV)-positive, the DNA synthesis of hepatocytes, and the risk for HCC were studied.

METHODS

Thirty-eight patients with anti-C-100 antibody-positive and Child's grade A posthepatitic cirrhosis were studied. DNA synthesis activity was measured by a bromodeoxyuridine (BrdU, a thymidine analogue)-labeling index (LI), using the BrdU-anti-BrdU in vitro method, and the patients were followed prospectively by frequent liver ultrasonography for 3 years. The ultrasound patterns were classified into fine, coarse, and coarse-nodular (CN) patterns, and the reproducibility of the classification in practical use also was confirmed.

RESULTS

Of the 21 patients with high DNA synthesizing cirrhosis (BrdU LI > or = 1.5%), 10 (48%) showed coarse-nodular, 5 (24%) coarse, and 6 (29%) fine pattern in ultrasonography. Conversely, of the 17 patients with low DNA synthesizing LC (BrdU LI < 1.5%), only 1 (6%) showed coarse-nodular, 2 (12%) coarse, and 14 (82%) fine pattern. A significant relationship was found between the two groups of BrdU LI and ultrasound imaging patterns (P < 0.05). The incidence of CN pattern was significantly higher (P < 0.01) in the high DNA synthesizing group than in low DNA synthesizing group. Of the 11 patients with CN pattern by ultrasound imaging, 10 (91%) were in the high DNA synthesizing group, and 9 (82%) developed HCC during the follow-up period, compared with 3 of 7 (43%) with coarse, and only one of 20 (5%) with fine pattern developed HCC. The incidence of HCC was significantly higher (P < 0.01) in patients with a CN cirrhosis pattern than in those with a fine pattern.

CONCLUSIONS

In patients with cirrhosis who are anti-HCV-positive, the CN pattern by ultrasound imaging indicates increased DNA synthesis of hepatocytes and a high risk for developing HCC.

摘要

背景

研究了抗丙型肝炎病毒（HCV）阳性的肝硬化患者的超声图像模式、肝细胞DNA合成与肝癌发生风险之间的关系。

方法

对38例抗C-100抗体阳性且Child分级为A级的肝炎后肝硬化患者进行研究。采用体外BrdU-抗BrdU法，通过溴脱氧尿苷（BrdU，一种胸腺嘧啶类似物）标记指数（LI）测量DNA合成活性，并对患者进行为期3年的定期肝脏超声随访。超声图像模式分为细、粗和粗结节（CN）模式，并证实了该分类在实际应用中的可重复性。

结果

在21例DNA合成活跃的肝硬化患者（BrdU LI≥1.5%）中，10例（48%）超声表现为粗结节模式，5例（24%）为粗模式，6例（29%）为细模式。相反，在17例DNA合成不活跃的肝硬化患者（BrdU LI＜1.5%）中，仅1例（6%）表现为粗结节模式，2例（12%）为粗模式，14例（82%）为细模式。两组BrdU LI与超声图像模式之间存在显著相关性（P＜0.05）。高DNA合成组的CN模式发生率显著高于低DNA合成组（P＜0.01）。在超声表现为CN模式的11例患者中，10例（91%）属于高DNA合成组，其中9例（82%）在随访期间发生肝癌；相比之下，7例粗模式患者中有3例（43%）发生肝癌，20例细模式患者中仅有1例（5%）发生肝癌。CN肝硬化模式患者的肝癌发生率显著高于细模式患者（P＜0.01）。