Hepatocarcinogenetic Studies in Myanmar Thalassemiacs

本研究于1996年12月24日至1997年1月7日和1997年12月17日至27日在仰光总医院医学研究科、仰光总医院肝血科和仰光儿童医院进行了调查，目的是对缅甸人群中铁超载和肝细胞癌(HCC)的流行情况进行流行病学调查，以阐明在HC发病过程中铁超载与其他因素(如乙肝和丙型肝炎病毒感染等)的关系。共调查104例患者，其中肝细胞癌28例，地中海贫血38例。经患者同意采血。结果：L)肝炎病毒标志物：94%的肝病患者既往有乙肝病毒感染史。36例(35%)患者存在持续的乙肝病毒感染。抗-丙型肝炎病毒抗体阳性患者中，有79%的患者存在持续的丙型肝炎病毒感染。31%的患者被怀疑有持续性的丙型肝炎病毒感染。46%的人肝细胞癌仅与乙肝病毒有关，7%的人同时与乙肝病毒和丙型肝炎病毒有关，21.4%的人与丙型肝炎病毒有关。52%的患者抗-丙型肝炎病毒抗体阳性，41%的患者被怀疑有持续性的丙型肝炎病毒感染。2)铁超载状况：几乎所有调查的患者都有某种与铁代谢有关的异常。三分之二的肝病患者表现为低TIBC，所有地中海贫血患者都表现出转铁蛋白铁饱和度和游离铁升高(Gutteridge法)。缅甸住院患者的意外发现是丙型肝炎病毒感染的流行。人们认为抗击这一流行病势在必行。关于丙型肝炎病毒感染的另一个令人惊讶的发现是，已确定的病毒亚型都是Lb。必须建立丙型肝炎监测体系。在肝病患者中发现铁超载，必须进行治疗。

The aim of the present study is to make the epidemiological survey on the prevalence of iron overload and hepatocellular carcinoma (HCC)among Myanmar population, and clarify the association of iron overload with other factors such as hepatitis B and C virus (HBV and HCV) infection in the development of HCC.The survey was conducted from 24 December 1996 to 7 January 1997, and from 17 to 27 December 1997 at the Department of Medical Research ; the Section of Hepatology and Haematology, Yangon General Hospital ; and the Yangon Children's Hospital. 104 patients including 28 patients of HCC,38 thalassemiacs were surveyed. Their blood was collected with consent from the patients.The results were :l) Hepatitis virus markers : 94% of the liver patients had the past history of HBV infection. Persistent HBV infection was found in 36 patients (35%). HCV-RNA positivity that means persistent HCV infection was 79% among anti-HCV antibody positive patients. 31% of the total patients was suspected to have persistent HCV infection. 46% of HCC was related to HBV only was, 7% to both HBV and HCV,21.4% to HCV.HCV infection were more prevalent among transfuction dependent thalassemiacs. 52% were positive for anti-HCV antibody, and41% are suspected to have persistent HCV infection.2)Iron overload status : Almost all the patients survey had some kind of abnormalities concerning iron metabolism. Two thirds of the hepatology patients showed low TIBC.All the thalassemiacs showed increased transferrin iron saturation and free iron (Gutteridge method).Surprising findings among Myanmar in-patients were the epidemic of hepatitis C virus infection. It is felt imperative to combat the epidemic. Another surprising findings about HCV infection was the identified virus subtype was all lb. Survey system for hepatitis C must be constructed. lron overload found among patients with liver disease must be treated.