丙型肝炎相关肝细胞癌。患病率及意义。

Hepatitis C-related hepatocellular carcinoma. Prevalence and significance.

作者信息

Resnick R H, Koff R

机构信息

Department of Medicine, Beth Israel Hospital, Boston, Mass.

出版信息

Arch Intern Med. 1993 Jul 26;153(14):1672-7.

PMID:7687423

Abstract

BACKGROUND

In reports from worldwide sources, antibodies to hepatitis C virus (HCV) have been observed in patients with primary hepatocellular carcinoma (HCC). The current survey is designed to analyze the prevalence and significance of the relationship of HCV infection to HCC.

METHODS

A MEDLINE search terminating on October 1, 1991, produced 15 reports from eight nations in which the frequency of antibodies to HCV by an enzyme-linked immunosorbent assay test in HCC and control groups was obtained. Patient gender, occurrence of cirrhosis, role of alcoholism and transfusion history, and seropositivity for HCV and hepatitis B viral (HBV) markers were recorded.

RESULTS

Among 1930 patients with HCC, antibodies to HCV were found in 47% (95% confidence interval [CI], 37% to 57%), while HBV markers occurred in 59% (95% CI, 27% to 91%) of subjects studied; hepatitis B surface antigen (HBsAg) positivity was noted in 37% (95% CI, 18% to 56%). The odds ratio (OR) for HBV markers relative to HCV antibodies was 1.73 (95% CI, 1.52 to 1.96) and for HCV antibodies relative to HBsAg, 1.40 (95% CI, 1.23 to 1.59). Among HBsAg-positive subjects, 25% had seropositivity for HCV, but for HBsAg-negative patients, 59% were HCV antibody positive (P < .001). Male gender and cirrhosis were prominent factors (92% +/- 7% and 88 +/- 6%, respectively). The OR for HCC in patients with antibody to HCV compared with controls was 25 (95% CI, 18 to 33). The OR comparing HCC with chronic liver disease with respect to HCV antibodies was 0.81 (95% CI, 0.65 to 1.01). We applied chi 2 tests to each report to detect, if present, a pattern of dominance favoring HCV, HBV markers, or HBsAg; none was observed.

CONCLUSIONS

The prevalence of HCV seropositivity in HCC is substantial and virtually comparable with HBV. Hepatocellular carcinoma is usually associated with chronic liver disease, which may be required for tumor transformation. Both HCV and HBV may function independently in the pathogenesis of HCC.

摘要

背景

在来自世界各地的报告中，原发性肝细胞癌（HCC）患者体内已检测到丙型肝炎病毒（HCV）抗体。本次调查旨在分析HCV感染与HCC关系的患病率及意义。

方法

对截至1991年10月1日的MEDLINE数据库进行检索，得到来自8个国家的15份报告，其中记录了通过酶联免疫吸附试验检测HCC组和对照组中HCV抗体的频率。记录患者的性别、肝硬化的发生情况、酗酒和输血史，以及HCV和乙型肝炎病毒（HBV）标志物的血清学阳性情况。

结果

在1930例HCC患者中，47%（95%置信区间[CI]，37%至57%）检测到HCV抗体，而在所研究的受试者中，59%（95%CI，27%至91%）出现HBV标志物；37%（95%CI，18%至56%）的患者乙型肝炎表面抗原（HBsAg）呈阳性。HBV标志物相对于HCV抗体的优势比（OR）为1.73（95%CI，1.52至1.96），HCV抗体相对于HBsAg的OR为1.40（95%CI，1.23至1.59）。在HBsAg阳性的受试者中，25%的人HCV血清学阳性，但在HBsAg阴性的患者中，59%的人HCV抗体阳性（P <.001）。男性和肝硬化是显著因素（分别为92%±7%和88%±6%）。与对照组相比，HCV抗体阳性患者发生HCC的OR为25（95%CI，18至33）。就HCV抗体而言，HCC与慢性肝病相比的OR为0.81（95%CI，0.65至1.01）。我们对每份报告应用卡方检验，以检测是否存在有利于HCV、HBV标志物或HBsAg的优势模式；未观察到这种情况。