华支睾吸虫病诱发原发性肝细胞癌的危险性评价

Evaluation of the risk of clonorchiasis inducing primary hepatocellular carcinoma

目的探讨华支睾吸虫病与原发性肝细胞癌的关系及其与HBV感染、饮酒的协同致病作用。方法采用病例对照研究的方法，以444例原发性肝细胞癌患者及同期住院500例非肿瘤患者为研究对象，比较两组间华支睾吸虫病合并状况，评价华支睾吸虫病发生原发性肝细胞癌的危险眭以及与HBV感染、饮酒的协同致病作用。结果病例组华支睾吸虫病合并率为16．44％，对照组合并率为2．40％，两组间差异有统计学意义（X^2=56．58，P〈0．01），有华支睾吸虫病者发生原发性肝细胞癌的OR值为8．00（95％CI．4．34～14．92），其中病程不足10年者并发原发性肝细胞癌的OR值为4．82（95％CI：2．32～10．26），10年及以上者OR值为17．54（95％CI：5．47～57．18）。华支睾吸虫病与HBV感染和华支睾吸虫病与饮酒之间呈正相加交互作用，其交互作用超额相对危险度分别是110．43和18．23；交互作用归因比分别是0．80和0．63；交互作用指数分别是5．18和2．84。结论华支睾吸虫病可能是原发性肝细胞癌的重要危险因素之一；随着华支睾吸虫病病程的延长，华支睾吸虫病者并发原发性肝细胞癌危险性增加；华支睾吸虫病与HBV感染或饮酒在原发性肝细胞癌的发生中可能具有协同致病作用。

Objective To explore the relationship between clonorchiasis and primary hepatocellular carcinoma （HCC） and analyze the synergistic actions of HBV infection, alcohol consumption and clonorchiasis on HCC development. Methods This hospital-based case-control study was conducted among 444 HCC patients （cases） and 500 non tumor patients （controls） to compare the prevalence of clonorchiasis in the cases and the controls. The risk of clonorchiasis and the synergistic actions between HBV infection, alcohol consumption and clonorchiasis on HCC development were analyzed by crossover analysis and multiple logistic regression. Results The prevalence ofclonorchiasis in the cases （16.44%） was much higher than that of the controls （2.40%） （ x^2 = 56.58, P 〈 0.01）. In the case group, the OR value of those with clonorchiasis was 8.00 （95% CI： 4.34-14.92）. The OR value was 4.82 （95% CI： 2.32-10.26） for the subjects whose clonorchiasis was diagnosed 〈 10 years before their diagnosis of HCC, and was 17.54 （95% CI： 5.47-57.18） for those whose HCC was diagnosed more than 10 years ago. HBV infection, alcohol consumption and clonorchiasis showed an additive interaction in the development of HCC, with a relative excess risk of interaction of 110.43 and 18.23; attributable proportion of interaction of 0.80 and 0.63; synergy index of 5.18 and 2.84, respectively. Conclusion Clonorchiasis could be an important risk factor for HCC. When the course of clonorchiasis is prolonged, the risk of HCC could increase. HBV infection, alcohol consumption and clonorchiasis might have synergistic actions on the development of HCC.