Risk factors of hepatocellular carcinoma in Haimen, China

为阐明肝细胞癌（HCC）的致病因素，包括肝炎病毒、霉菌毒素和微囊藻毒素（MCs），在中国海门进行了多学科的流行病学研究。B肝炎病毒（HBV）是HCC发生的主要病毒，而不是丙型肝炎病毒（HCV）。不仅霉菌毒素和MCs是HCC的致病因素，而且HBV和MCs也是HCC的致病因素。在主食中检测到黄曲霉毒素B_1（AFB_1）、伏马菌素（fumonisins）和枯草杆菌毒素（Escherichthecenes），而在肝癌组织中检测到AFB_1白蛋白加合物和<1->AFB_1特异性p53突变。在池塘、沟渠和河水中检测到MCs，但病例组和对照组饮用水受MCs污染的频率和持续时间无差异。慢性肝炎和肝硬化的家族史在病例中比对照组更常见。为了预防中国海门市HCC的发生，通过疫苗和免疫接种进行HBV感染的干预似乎是最有效的策略。摄入黄曲霉毒素B_1污染的食物似乎不再重要。饮用水中MCs在肝癌发生发展中的作用尚不明确，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.