乙型肝炎病毒感染与肝癌相关性的多因素分析

Multivariate analysis of relationship between hepatitis B virus infection and hepatocellular carcinoma

目的探讨乙型肝炎病毒(HBV)感染与肝癌发生的相关因素,为其临床研究及防治提供可参考依据,以达降低肝癌发病率。方法纳入64例入住医院诊断为肝癌且合并有HBV感染的患者作为观察组,同时抽取112例仅存在HBV感染无肝癌发生的患者作为对照组,所有患者均空腹抽取静脉血检测血清TNF-α水平、HBV血清标记物及前C区nt1896位点的基因型。结果观察组HBsAg+、抗-Hbe、抗-HBc患者例数明显高于对照组,观察组患者血清TNF-α水平(28.4±11.2)pg/ml,对照组患者(18.8±10.5)pg/ml,两组比较差异均有统计学意义(P<0.05);两组间基因型、等位基因频率及显性模型比较差异无统计学意义,但两组间隐性模型比较差异有统计学意义(P<0.05);多因素分析结果表明血清TNF-α水平升高、nt1896位点为CC+GC隐性模型是HBV相关肝癌发生的独立危险因素。结论 HBV相关肝癌的发生与血清TNF-α水平的升高及nt1896位点检测为CC+GC隐性模型存在密切的相关性,对HBV感染患者进行血清TNF-α水平的检测,有条件可行HBV前C区nt1896位点的基因型检测,有助于降低HBV相关肝癌的发生。

OBJECTIVE To explore the relationship between the hepatitis B virus （HBV） infection and hepatocellular carcinoma and provide guidance for clinical study and prevention so as to reduce the incidence of hepatocellular carcinoma. METHODS Totally 64 patients with confirmed hepatocellular carcinoma complicated with HBV infection were assigned as the observation group, meanwhile, 112 patients with single HBV infection were set as the control group, then the fasting venous blood was sampled from all the patients for the test of serum TNF-α level, HBV serum markers, and genotypes of pre-C nt1896 ioci. RESULTS The number of the patients with positive HBsAg＋, anti-Hbe, or anti-HBc was significantly larger in the observation group than in the control group; the serum TNF-α level was （28.4±11.2）pg/ml in the observation group, （18. 8±10.5）pg/ml in the control group, and there was significant difference between the two groups （P〈0.05）. The difference in the genotypes, allele frequency, or dominant model between the two groups was not significant, but the difference in the recessive model between the two groups was significant （P〈0.05）. The results of multivariate analysis indicated that the elevated level of serum TNF-α level and the nt1896 loci as recessive model of CC＋GC were the independent risk factors for the HBV-related hepatoceUular carcinoma. CONCLUSION The incidence of HBV-associated hepatocellular carcinoma is closely associated with the elevated level of serum TNF-α level and the nt1896 loci confirmed as the recessive model of CCA-GC. It is an effective way to detect the serum TNF-α level for the patients with HBV infection and perform the test of genotypes of pre-C nt1896 loci if conditions permits so as to reduce the incidence of HBV-associated hepatocellular carcinoma.