Analysis of risk factors for hepatocellular carcinoma in patients with HBs antigen- and anti-HCV antibody-negative alcoholic cirrhosis: clinical significance of prior hepatitis B virus infection.-猫眼课题宝

HBs抗原和抗HCV抗体阴性酒精性肝硬化患者发生肝细胞癌的危险因素分析：既往乙型肝炎病毒感染的临床意义

DOI：

发表时间：

2003

期刊：

Alcoholism: Clinical and Experimental Research

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作者：

Shinichiro Uetake;M. Yamauchi;Shuji Itoh;O. Kawashima;K. Takeda;M. Ohata

背景在酒精中毒的肝细胞癌（HCC）患者中经常检测到B型肝炎病毒（HBV）或丙型肝炎病毒（HCV）标志物。然而，在乙肝表面抗原（Ag）和抗-HCV抗体（抗-HCV）阴性的酒精性肝硬化患者中发生肝细胞癌的危险因素尚未明确记录。本研究旨在阐明HBsAg阴性和抗HCV阴性男性酒精性肝硬化中HCC的发生率，并评估肝细胞癌发生的危险因素。方法我们前瞻性研究了91例连续的乙肝表面抗原阴性和抗-HCV阴性酒精性肝硬化患者，研究时间为0.5 - 12.5年（中位时间为5.9年）。评估的肝癌发生的潜在危险因素包括以下6个变量：年龄、总酒精摄入量、诊断后持续酒精摄入的相关性、15分钟时吲哚菁绿色留存率、抗HB核心抗体（抗HBc）和糖尿病相关性。结果第5、7、10年末HCC的累积发生率分别为6.4%、18.9%、28.7%。按抗-HBc分类，31例抗-HBc阳性患者和60例抗-HBc阴性患者第5年肝癌发生率分别为15.6%和2.9%，7年分别为28.4%和13.5%，10年分别为40.4%和22.1%。肝细胞癌的发生率也与累积饮酒量显著相关。考克斯比例风险模型显示，累积饮酒（p = 0.0047）和抗-HBc抗体阳性（p = 0.0598）与HCC的发生率独立相关。结论这些流行病学结果表明，大量累积饮酒和既往暴露于HBV感染是HBsAg和抗HCV阴性酒精性肝硬化患者发生HCC的危险因素。

BACKGROUND The hepatitis B virus (HBV) or hepatitis C virus (HCV) markers frequently are detected in alcoholic patients with hepatocellular carcinoma (HCC). However, risk factors for the development of HCC in patients with HBs antigen (Ag)- and anti-HCV antibody (anti-HCV)-negative alcoholic cirrhosis have not been clearly documented. The present study was conducted to elucidate the occurrence rates of HCC in HBs Ag- and anti-HCV-negative male alcoholic cirrhosis and to assess the risk factors for hepatocellular carcinogenesis. METHOD We prospectively studied 91 consecutive patients with HBs Ag- and anti-HCV-negative alcoholic cirrhosis for 0.5 to 12.5 years (median 5.9 years). Potential risk factors assessed for liver carcinogenesis included the following six variables: age, total alcohol intake, association of continuing alcohol intake after diagnosis, indocyanine green retention rate at 15 min, anti-HB core antibodies (anti-HBc), and association of diabetes mellitus. RESULTS Cumulative occurrence rates of HCC were 6.4%, 18.9%, and 28.7% at the end of the 5th, 7th and 10th years, respectively. When classified by anti-HBc, the occurrence rates of HCC in 31 patients with anti-HBc and 60 patients without anti-HBc were 15.6% and 2.9% at the 5th year, 28.4% and 13.5% at the 7th year, and 40.4% and 22.1% at the 10th year, respectively. The occurrence rates of HCC were also significantly related to the cumulative alcohol intake. Cox proportional hazard model identified that cumulative alcohol intake (p = 0.0047) and positive anti-HBc antibodies (p = 0.0598) were independently associated with the occurrence rates of HCC. CONCLUSION These epidemiologic results suggest that heavy cumulative alcohol intake and prior exposure to HBV infection are risk factors for the development of HCC in patients with HBs Ag- and anti-HCV-negative alcoholic cirrhosis.

Hepatitis B virus integration site in hepatocellular carcinoma at chromosome 17;18 translocation.