肝炎病毒感染、饮酒与肝细胞癌病例对照研究

Case-control study on hepatitis virus infection,alcohol drinking,and hepatocellu ar carcinoma

目的 研究乙型肝炎病毒、丙型肝炎病毒及饮酒与肝细胞癌的关系。方法 应用成组病例对照研究设计 ,选择 1999年 10月～ 2 0 0 2年 8月间住院初诊为肝细胞癌患者 16 4例作为病例组 ;选择性别、年龄、入院时间等与病例组均衡可比的眼科、皮肤科、泌尿科、心脏内科、呼吸内科患者 2 6 8例 ,作为对照组 ;通过非条件Logistic回归分析 ,探讨肝炎病毒感染、饮酒与肝细胞癌的相关性及病毒感染与酒精之间的协同作用。结果 肝细胞癌病例组HBsAg阳性率为 6 5 .2 % ,HCVRNA阳性率为 4 .9% ;对照组HBsAg阳性率为 10 .1% ,HCVRNA阳性率为 0 .7% ;病例组中有重度饮酒史 (每天酒精摄入量 >80 g ,至少 5年 )者占 5 8.5 % ,对照组中占 36 .9%。HBsAg阳性、HCVRNA阳性及重度饮酒的优势危险比 (OR)值分别为 16 .76 (95 %CI :10 .0 5～ 2 7.93) ,6 .92 (95 %CI :1.4 5～ 33.0 1)和 2 .4 1(95 %CI:1.6 2～3.5 9) ;HBsAg和HCVRNA均阳性与重度饮酒之间有协同增效作用。HBV感染是肝癌的最主要的相关原因 ,人群归因危险度 (AR)为 94 ,0 3% ,其次是HCV感染 ,AR为 6 8% ,以及重度饮酒 ,AR为 5 8.5 %。结论 肝炎病毒感染及饮酒与肝细胞癌的发生有关 ,对肝癌发生的危险度有叠加作用。

Objective To study the association of hepatitis B virus(HBV),hepatitis C virus(HCV)infecti on alcohol drinking with hepatocelluar carcinoma(HCC).Methods 164 subjects with an initia l diagnosis of HCC,who were admitted to our hospital and the other two major hos pitals in Jinan of Shandong province,were recruited.And 268 subjects,who were se x-,age-,and hospital-matc hed and were admitted to the Departments of Ophthalmology,Dermatology,Urology ,Ca rdiology and Respiratory Medicine were grouped as control.To investigate the re lationship o f HCC with HBV,HCV and alcohol drinking,the interaction between hepatitis virus and alcohol by unconditional logistic regression analysis using the maximum lik elihood method.Results Zn the HCC cases,65.2% were positive for HBsAg an d 4.9% for HCV RNA;among the control,10.1% were positive for HBsAg and 0.7% for HCV RNA.History of heavy alcohol intake(80g of alcohol per day for at least 5 years)was found among 58.5% of the cases and among 36.9% of the control.The odds ratio(OR)f or H BsAg,HCV RNA positivity,and heavy alcohol intake was respectively,16.76(95% conf idence interval 10.05-27.93),6.29(95% confidence interval 1.45-33.01),2.41(95% c onfidence interval 1.62-3.59).Positive synergisms between both HBsAg positive an d HCV RNA positive and heavy alcohol intake were found.On the basis of populatio n attributable risks(AR),HBV infection seemed to be the single most relavent caus e of HCC in the study(AR=94.03%),followed by HCV infection(AR=68%),and heavy alcoh ol intake (AR=58.5%).Conclusion The association of hepat itis virus and alcohol with HCC,more than additive effects of viral infections a nd alcohol drinking on the risk of HCC.