Increased risk of hepatocellular carcinoma in male hepatitis B surface antigen carriers with chronic hepatitis who have detectable urinary aflatoxin metabolite M1
Increased risk of hepatocellular carcinoma in male hepatitis B surface antigen carriers with chronic hepatitis who have detectable urinary aflatoxin metabolite M1
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DOI：
10.1002/hep.510300204
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发表时间：
1999-08-01
期刊：
影响因子：
13.5
通讯作者：
Zhu, YR
中科院分区：
文献类型：
--
作者：
Sun, ZT;Lu, PX;Zhu, YR
我们对145名慢性B型肝炎（HBV）患者进行了为期10年的随访，以确定是否暴露于黄曲霉毒素，或同时暴露于丙型肝炎病毒（HCV），或肝细胞癌（HCC）家族史增加了发生HCC的风险。我们在开始随访前收集了8个月的尿液样本，并将其合并用于检测黄曲霉毒素代谢产物M1（AFM 1），其中78例（54%）受试者检测到AFM 1。在可检测到AFM 1（高于3.6 ng/L）的患者中，HCC的风险增加了3.3倍（95%置信区间为1.2-8.7）。暴露于可检测的AFM 1的归因风险为0.553（0.087，0.94）。AFM 1升高的患者发生致命性肝硬化的相对风险为2.8（0.6，14.3），可检测到AFM 1的患者丙氨酸转氨酶（ALT）持续升高的几率是正常人的2.5倍（P = 0.007）。合并HCV感染使HCC的风险增加5.8倍（2.0-17），经年龄和AFM 1状态校正。HCC家族史增加HCC风险5.6倍，经年龄和AFM 1校正。4例AFM 1和HCC患者癌组织中p53基因第249位密码子均发生错义突变。这项研究表明，暴露于AFM 1可以解释慢性HBV肝炎男性HCC风险的很大一部分，并增加了重要的证据，即HCV和HCC家族史增加了慢性HBV肝炎男性HCC的风险。
We followed 145 men with chronic hepatitis B virus (HBV) hepatitis for 10 years to determine whether exposure to aflatoxin, or concomitant exposure to hepatitis C virus (HCV), or family history of hepatocellular carcinoma (HCC) increased the risk of developing HCC. We collected 8 monthly urine samples before beginning follow-up and pooled them to detect aflatoxin metabolite M1 (AFM1), AFM1 was detected in 78 (54%) of the subjects. The risk of HCC was increased 3.3-fold (with a 95% confidence interval of 1.2-8.7) in those with detectable AFM1 (above 3.6 ng/L), This relative risk was adjusted for age and for HCV status. The attributable risk from exposure to detectable AFM1 was 0.553 (0.087, 0.94). The relative risk of fatal cirrhosis for those with elevated AFM1 was 2.8 (0.6, 14.3), and the odds of having a persistently elevated alanine transaminase (ALT) were 2.5-fold greater in those with detectable AFM1 (P =.007). Concomitant infection with HCV increased the risk of HCC 5.8-fold (2.0-17), adjusted for age and AFM1 status. A family history of HCC increased the risk of HCC 5.6-fold, adjusted for age and AFM1. Four men with detectable AFM1 and HCC all had missense mutation in codon 249 of the p53 gene in cancer tissues. This study shows that exposure to AFM1 can account for a substantial part of the risk of HCC in men with chronic HBV hepatitis and adds importantly to the evidence that HCV and family history of HCC increase the risk of HCC in men with chronic HBV hepatitis.