Risk factors of hepatocellular carcinoma in Haimen, China

为了阐明肝细胞癌的病因，包括肝炎病毒、霉菌毒素和微囊藻毒素，在中国海门市进行了多学科的流行病学研究。在肝癌组织中发现了肝细胞癌的主要病毒--乙型肝炎病毒，而不是丙型肝炎病毒。不仅在主食中发现了真菌毒素黄曲霉毒素B_1、伏马菌素和毛霉烯类毒素，而且在肝细胞癌组织中发现了黄曲霉毒素B_1白蛋白加合物。在池塘、沟渠和河水中检出MCs：但病例组和对照组饮用水中MCs污染的频率和持续时间没有差异。慢性肝炎和肝硬变家族史患者较对照组多见，中国认为，通过疫苗和免疫干预乙肝病毒感染可能是预防海门市肝癌发病最有效的策略。摄入受黄曲霉毒素B_1污染的食物似乎不再重要。饮用水中MC在肝细胞癌发生发展中的作用尚不清楚，有待进一步研究。

To elucidate etiologic factors of hepatocellular carcinoma (HCC), including hepatitis viruses, mycotoxins and microcystins (MCs), multidisciplinary epidemiologic studies were done in Haimen, China.Hepatitis B virus (HBV), but not hepatitis C virus (HCV), was a major virus in the development of HCC.Not only mycotoxins (eg.aflatoxin B_1[AFB_1], fumonisins, and trichothecenes) in staple food but AFB_1 albumin adducts were detected, and AFB_<1->specific mutations of p53 were observed in the tissue of liver cancer. MCs were detected in the pond, ditch and river water : however, the frequency and duration of drinking water contaminated with MCs were not different between cases and controls. Family histories of chronic hepatitis and liver cirrhosis were more frequent in cases than controls.To prevent the onset of HCC in Haimen, China, an intervention of HBV infection via vaccine and immunization seems the most effective strategy. Intake of food contaminated with AFB_1 does not seem important anymore. The effect of MCs in the drinking water in the development of HCC was not clear in this study and waits further investigations.