肝细胞癌和其它慢性肝病HCV HBV感染比较分析

COMPARATIVE ANALYSIS OF HCV AND HBV INFECTIONSIN HCC CASES AND IN OTHER PATIENTSWITH CHRONIC LIVER DISEASES

对１２８例有病理诊断依据的肝细胞场（ＨＣＣ）、４７例慢迁肝（ＣＰＨ）、１０５例慢活肝（ＣＡＨ）、４６例肝硬化（ＬＣ）．采用嵌套式ＰＣＲ技术检测其血标本中的丙型肝炎病毒（ＨＣｖ）ＲＮＡ和乙型肝炎病毒（ＨＢＶ）ＤＩＩＡ，对这两种病毒的血清学标志也进行了研究。结果：在ＨＣＣ组。ＨＣＶＲＮＡ１４．１％阳性，ＨＢＶＤＮＡ７ｉ．３％阳性。ＣＰＨ，ＣＡＨ，ＬＣ和ＨＣＣ的ＨＢＶ感染率均在９０％左右，而ＨＣＶ感染率则分别为８．５％、９．５％、１７．４％和１９．５％，显示ＨＣＶ感染率随肝病严重程度的增加而有增加的趋势；晚期肝病组的ＨＣＶ感染率（１９．０％）显著高于慢性肝炎组（９．２％，Ｐ＜０．０５）。提示ＨＣＶ感染后经过慢性肝炎、肝硬化发展为ＨＣＣ可能是一个逐渐演进的病理过程。ＨＣＶ，ＨＢＶ重叠感染率。ＨＣＣ组高于ＣＰＨ，ＣＡＨ，而与ＬＣ相近，显示ＨＣＶ重叠感染在原有ＨＢＶ感染的基础上促进病变向着迁延化、慢性化，进而向着肝硬化、ＨＣＣ方向发展。

he purpose of this paper was to evaluate the causative role of HCV infection and HBV infection in the development of HCC and to find out the possible course of evolution from HCV infection to HCC. 128 HCC cases proved histologically, 47 patients with chronic persis- tent hepatitis (CPH), 105 patients with chronic active hepatitis (CAH) and 46 patients with liver cirrhosis (LC) were detected for HCV RNA and HBV DNA in blood samples by nested PCR. The serum markers of HBV and HCV were also assayed by using ELISA technique. Among 128 patients with HCC, HCV RNA was detected in 18 (14.1%) , and HBV DNA wasdetected in 99(77.3%). HCV infection was defined as HCV RNA and/or anti-HCV positive,HBV infection was defined as HBV DNA and/or HBsAg positive. HBV infection was foundin about 90% of CPH, CAH, LC and HCC groups. While HCV infection was found in 8.5%of CPH group, 9.5% of CAH group, 17.4% of LC group and 19.5% of HCC group sug gesting an increase of HCV infection rate along with increase in severity of the liver diseases. The HCV infection rate in the group with advanced stage of liver disease (LC and HCC) was 19.0%, significantly higher than that in the group with only chronic hepatitis (CPH and CAH) (9.2%, P<0.05) , indicating a gradual trarisition of pathologic changes from chronic hepatitis, liver cirrhosis to HCC after HCV infection. On the other hand, cases with overlap- ping HCV and HBV infections were higher in HCC (14.1%) and LC (15.2%) , in comparison with CPH (6.4%) and CAH (2.9%), suggesting superinfection of HCV on the background of HBV infection would enhance the development from chronic hepatitis to liver cirrhosis and ultimately HCC.