HBeAg与原发性肝癌和病毒相关因素的分析

Analysis of Virological Characteristics on HBeAg Positive Primary Hepatic Carcinoma

目的研究HBeAg阴性与HBeAg阳性的原发性肝癌患者临床特点和病毒相关因素的差异,并探讨其临床意义。方法对1028例原发性肝癌患者的住院病历进行回顾性调查,将患者分为HBeAg阳性组和阴性组。分析两组门脉癌栓、AFP水平、HBV DNA定量、Child-Paugh分级及肝组织病理学指标的差异。结果 HBeAg阴性原发性肝癌895例,占总数的87.1%;HBeAg阳性原发性肝癌133例,占总数的12.9%;HBeAg阳性组合并门脉癌栓的比例为18.6%,显著高于HBeAg阴性组的11.8%(χ2=4.46,P=0.035)。HBeAg阳性组HBV DNA定量对数均值显著高于HBeAg阴性组(χ2=12.81,P=0.00);HBeAg阳性组Child-Paugh分级为B级和C级的分别为18.3%和15.0%,明显高于HBeAg阴性组的12.9%和1.0%;HBeAg阳性组肝纤维化分期为4期的比例为35.5%,明显高于HBeAg阴性组的24.5%(χ2=4.98,P=0.026)。两组在AFP等指标上无统计学差异。结论同HBeAg阴性原发性肝癌相比,HBeAg阳性肝癌患者肝组织学损害程度较重,合并门脉癌栓、肝硬化更为常见,预后更差。

Objective To evaluate the relationship between positivity of HBeAg and the development of primary hepatic cancer.Methods A total of 1028 in-patient PHC cases were retrospectively analyzed.Portal vein tumor thrombus,serum AFP values,HBV DNA levels Child-Paugh Grading and histologic alterations were analyzed in both HBeAg-positive group and HBeAg-negative group.Results Of the 1028 cases,895（87.1%） were HBeAg-negative and 133（12.9%） were HBeAg-positive.Compared with HBeAg-negative group,HBeAg-positive group had a significantly higher Portal vein tumor thrombus rate（χ2=4.46,P=0.035）,significantly higher DNA levels（χ2=12.81,P=0.00）.Compared with HBeAg-negative group,HBeAg-positive group had a significantly higher Child-Paugh Grading B and C（χ2=82.97,P=0.00）.And the cases of hepatic fibrosis stage 4 had also higher in the HBeAg-positive group than in the HBeAg-negative group.No obvious difference in AFP levels was observed between these two groups.Conclusion There was more serious hepatic tissue injury in the HBeAg-positive group than in the HBeAg-negative group,and HBeAg-positive group had greater tendency of developing Portal vein tumor thrombus and liver cirrhosis with poor prognosis.