原发性肝癌高危人群队列前瞻20年结果分析

Analysis of twenty-year survey on the population at high risk of developing primary hepatic carcinoma

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 data of twenty-year prospective survey on the population at high risk of developing primary hepatic carcinoma（PHC） in Qidong Jangsu and investigate the relationship between hepatitis B and PHC.Methods The twenty-year prospective survey on the population at high risk of developing PHC in Qidong Jangsu was performed in 515 male hepatitis B virus（HBV） carriers with HBsAg positive aged 20 to 60 years old.During the period of survey,physical examination was done and blood samples were taken for the measurements of HBsAg,alanine aminotransferase（ALT） and AFP every 6 months or one year.B type ultrasound and CT immaging were carried out when necessary.A total of 64883 male people living in the same district aged 20 to 60 years old were taken as the controls.Results The morbidity of PHC in 515 HBV positive people was 1341.3/100000,which was 7.27 times as large as 184.5/100000 in the controls.The average age diagnosed PHC in HBV positive people was 43 years old,which was 2.25 to 5.82 years earlier than that（48 years old） in the controls.But the survival time of PHC patients was 150 to 197 days longer than that of the controls.The possibility of developing PHC was very significantly higher in the people with alpha fetus protein（AFP） positive than that in those with AFP negetive（P〈0.01）.Conclussion HBV infection is the most important factor for developing PHC.The population at high risk of developing PHC should be followed up regularly in order to getting early diagnosis and treatment,especially in those with low concentration of AFP.