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目的分析20年前瞻性调查结果,探讨原发性肝癌(肝癌)与乙型肝炎病毒感染的关系。方法在江苏启东市肝癌高发区对515例HBsAg携带、男性、年龄在20～60岁的肝癌高危人群,每6个月或1年进行一次临床体检、采血检测HBsAg、ALT、甲胎蛋白(AFP),B超、CT等进一步检查。同时,将该居住区相同时间段内20～60岁的全部男性64 883人列为对照组,进行了连续20年的前瞻观察。结果HBsAg阳性人群的肝癌年发病率高达1341.3/10万,是对照组184.5/10万的7.27倍。HBsAg阳性组发生肝癌时的中位年龄43岁;对照组则分别为48岁。各年龄段发现肝癌时HBsAg阳性组比对照组平均提早了2.25～5.82年,生存时间较对照组长150～197 d。随访中曾出现过AFP阳性人群发生肝癌的危险性极显著高于AFP阴性人群(P<0.01)。结论乙型肝炎病毒感染是肝癌最重要的病因因素。对肝癌高危人群进行定期随访,尤其是AFP低度阳性患者定期检测,可以发现早期肝癌患者,取得更好的治疗效果。
Objective To analyze the results of a 20-year prospective survey to investigate the relationship between primary liver cancer (HCC) and hepatitis B virus infection. Methods A total of 515 HBsAg-carrying, male, 20-to-60-year-old patients with high-risk liver cancer were enrolled in the high incidence area of hepatocellular carcinoma in Qidong, Jiangsu Province. Clinical examination was performed every 6 months or 1 year. Blood samples were collected for detection of HBsAg, ALT, ), B ultrasound, CT and other further examination. At the same time, 64 883 males from 20 to 60 years old in the same period of time in the residential area were selected as the control group, and prospective observation of 20 consecutive years was conducted. Results The annual incidence of liver cancer in HBsAg-positive population was 1341.3 / 100000, which was 7.27 times higher than 184.5 / 100000 in control group. The median age at onset of HCC in the HBsAg-positive group was 43 years; in the control group, they were 48 years. HBsAg positive group found liver cancer in all age groups than the control group an average of 2.25 ~ 5.82 years earlier, the survival time than the control group of 150 ~ 197 d. The risk of developing HCC in AFP-positive patients during follow-up was significantly higher than that in AFP-negative patients (P <0.01). Conclusion Hepatitis B virus infection is the most important cause of liver cancer. Regular follow-up of high-risk groups of liver cancer, especially AFP low-positive patients with regular testing, early liver cancer patients can be found to achieve better therapeutic effect.