422例原发性肝癌与乙肝病毒感染及相关肿瘤标志物的关系

Investigation of Relationship between Hepatitis B Virus Infection and Primary Liver Carcinoma or the Related Tumour Markers (Analysis of 422 cases)

目的:探讨原发性肝癌与乙肝病毒感染及相关肿瘤标志物的关系.方法:应用ELISA检测乙肝两对半(HBV-M),化学发光法检测AFP和CA199,酶法检测AFU共检测422例原发性肝癌病人血清中的乙肝两对半、AFP、CA199、AFU和725名普通住院病人的乙肝两对半, 并随机抽取148名三种乙肝病毒主要感染模式(大三阳、小三阳和HBsAg与抗HBc阳性)比较其癌变率.结果:原发性肝癌病人乙肝病毒感染率达94.1%,其感染模式的百分比构成以小三阳为主占5 3.6%,其次为HBsAg和抗HBc二项阳性占22.0%,而大三阳仅占8.3%,但这三种主要感染模式之间其癌变率无显著差异(χ2＝0.55,P＞0.05),在原发性肝癌病人中单独抗 HBs阳性或HBV-M全阴组CA199阳性率显著高于其他组,而AFP和AFU则显著低于其他组,这可能与原发性肝癌的病理类型有关.结论:原发性肝癌与乙肝病毒感染密切相关,e抗原转阴并不意味着组织学转为良好,相反由于其与e抗原阳性患者具有同等的癌变率,且在乙肝病毒感染者中占有最高的比例,我们应特别重视对这部分患者的定期随访,原发性肝癌患者AFP、CA199和 AFU的阳性率与乙肝病毒的感染有关.

Objective To investigate the relationship between hepatitis B virus infection and primary liver carcinoma (PLC) or the related tumour markers. Methods AFP、CA199、AFU and markers of hepatitis B virus (HBV - M)in 422 patients with PLC were detected by CLEIA(chemoluminescent enzyme immunoassay)、enzymatic method and ELISA(enzyme linked immunosorbent assay)re-spectively. HBV- M in 725 subjects as controls was determined also by ELISA. And the rates of PLC were compared among 148 patients with the major HBV - M combinations who were randomly selected. Results HBV - M( + ) was documented in 94.1% of the patients with PLC,among which the incidence of the combination of HBsAg( + ) ,HBcAg( + ) and HBCAb( + ) was found highest(53. 6% of the cases) ;the next was the combination of HBsAg( + ) and HBcAb( + )(22.0%) ;the combination of positive HBsAg、HBeAg and HBcAb was only in 8.3% of the cases. But the rates of PLC were insignificantly different among the patients wits the above combinations of HBV - M. The positive rate of CA199 in PLC patients with HBV - M( - ) was higher than that with HBV - M( + ). But the correlativity of AFP and AFU was contrary to the relationship between CA199 and HBV - M. Conclusions The present study furthur supports the intimate relationship between PLC and HBV, and we can not neglect the patients with hepatitis B who's HBeAg has turned to negative. The positive rates of AFP、CA199 and AFU in the patients with PLC may be associated with HBV infection.