Risk factors of hepatocellular carcinoma in Haimen, China

为了预防世界上发病率最高的中国海门的肝细胞癌（HCC），一项由Mombusho国际科学研究项目“1995-1996年癌症专项研究”资助的国际多学科研究正在进行中。在饮用水中检测到微囊藻毒素，这种毒素是由小溪、河流和池塘水中的藻类产生的，最近被认为是肝癌发生的促进剂。花生、玉米等主食中检出黄曲霉毒素B_1、伏马菌素等真菌毒素。到目前为止，收集了134对病例和对照。有既往史和家族史的病例较对照组多见。海门地区hcc主要与乙型肝炎病毒（HBV）相关，与丙型肝炎病毒无关。HBV的垂直感染和水平传播都可能导致hcc的发生。吸烟和饮酒都与hcc的发生无关。ALDH2和CYP2E1基因多态性与hcc无关。病例中TNFalpha活性高于对照组。海门的hcc与肝硬化或纤维化并不一定相关。观察到p53中黄曲霉毒素b_1相关的特异性突变。为了预防海门的hcc，预防HBV感染似乎是最重要的，建议减少真菌毒素污染食品的摄入。本研究未发现饮用水或微囊藻毒素与hcc之间可能存在关联。

In order to prevent hepatocellular carcinoma (HCC) in Haimen, China, where the incidence of HCC is the highest in the world, an international multidisciplinary research is now underway sponsored by the Mombusho International Scientific Research Project, Special Cancer Research during 1995-1996.Microcystins, toxins produced by the algae in the creek, river and pond water and recently alleged to be promoters of hepatocarcinogenesis, were detected in the drinking water.Mycotoxins, such as aflatoxin B_1 and fumonisins, were detected in staple food, such as peanuts and corns.So far, 134 pairs of cases and controls were collected. Past history and family history of chronic hepatic diseases in cases were more frequent than controls. HCCs in Haimen were mainly associated with hepatitis B virus (HBV) but not hepatitis C virus. Both vertical infection and horizontal transmission of HBV may be responsible for the onset of HCCs. Neither smoking nor alcohol drinking were related to the onset of HCCs. Genetic polymorphisms of ALDH2 and CYP2E1 were not associated with HCCs. The activity of TNFalpha in cases was highter than controls.HCCs in Haimen were not necessarily related to liver cirrhosis or fibrosis. Aflatoxin B_1-associated specific mutations in p53 were observed.To prevent HCCs in Haimen, prevention of HBV infection seems most important and reduced intake of mycotoxin-polluted food are advised. In this study, a possible association between drinking water or microcystins and HCCs were not detected in this study.