肝癌发生中乙肝病毒感染与黄曲霉毒素暴露的作用

Hepatitis B virus infection and aflatoxin exposure in the development of primary liver cancer

目的研究肝癌发生中乙型肝炎病毒（ＨＢＶ）与黄曲霉毒素（ＡＦ）的作用。方法在肝癌高发区，对７３７例乙型肝炎表面抗原（ＨＢｓＡｇ）阳性和６９９例ＨＢｓＡｇ阴性人群进行了１０年前瞻性研究，同时按１∶５的病例对照模式，随机对队列中３０例肝癌和相应的１５０例非肝癌人群进行血清中黄曲霉毒素Ｂ１白蛋白加成物（ＡＦＢ１Ａｌｂ）测定。结果（１）ＨＢｓＡｇ阳性组平均年肝癌发生率为８２４．１３／１０万，明显高于对照组的７０．９７／１０万，相对危险度（ＲＲ）为１１６１，其他肿瘤发病率两组间差异无显著意义（Ｐ＞０．０５）。（２）肝癌组人群血清中ＡＦＢ１Ａｌｂ阳性率为７６．７％，明显高于对照组的４８．７％，比值比（ＯＲ）为３４７，肝癌组人群血清中ＡＦＢ１Ａｌｂ的浓度也明显高于对照组（Ｐ＜０．０１）。结论ＨＢＶ感染及ＡＦ暴露是肝癌发生的重要病因因素。

Objective To investigate the role of hepatitis B Virus (HBV) infection and aflatoxin (AF) exposure in the development of primary liver cancer (PLC). Methods A 10 year prospective case control study was carried out in 737 HBsAg carriers and 699 HBsAg negative cases, and the aflatoxin B 1 albumin adducts (AFB 1 Alb) were detected in the serum of the cohort including 30 HBsAg postive cases and 150 control individuals according to the case control study model (ratio 1∶5) at random in the high prevalance area of PLC. Results The average year incidence rate was significantly higher in the HBsAg postive group (824.13/100 000) than in the control group (70.97/100 000, RR =11.61). There was no significant difference in the incidence rate of other tumors between the two groups ( P >0.05). The serum positive rate of AFB 1 Alb was significantly higher in the PLC group (76.67%) than in the control group (48.67%, OR =3.47), and the serum concentration of AFB 1 Alb was also significantly higher in the PLC group than in the control group ( P <0.01). Conclusion HBV infection and AF exposure are important etiological factors in the development of PLC and both result in carcinogenic synergy.