幽门螺杆菌感染与原发性肝癌发生发展的关系

Relationship between Helicobacter pylori infection and primary hepatic carcinoma

目的:幽门螺杆菌(Helicobacter pylori,H.p y l o r i)感染与原发性肝癌(p r i m a r y h e p a t i c carcinoma,PHC)的发生发展.方法:收集2010-03/2013-10广西医科大学附属肿瘤医院首次诊断为PHC患者临床资料及非肿瘤患者临床资料.探讨H.pylori与PHC发生发展的关系.然后,再对实验组进行二次收集,分两组数据,一组为乙型肝炎病毒(hepatitis B virus,HBV)组,为同时检测H.pylori14C-UBT值与HBV DNA拷贝数;另一组为甲胎蛋白(alpha-fetal protein,AFP)组,为同时检测同时H.pylori14C-UBT值与AFP浓度患者.分别研究H.pylori14C-UBT值与AFP浓度、HBV DNA拷贝数之间的关系,间接证明H.pylori与P H C的相关性.对于计数资料使用χ2检验,若为有序资料则用秩和检验;计量资料,采用相关分析.结果:PHC患者H.pylori阳性率为61.4%,高于非肿瘤患者28.7%.卡方检验结果示χ2=11.466,P<0.05,差异有统计学意义.胆管细胞型H.pylori的阳性率61.1%,混合细胞型50%,肝细胞型38.6%,以胆管细胞型阳性率最高;统计结果χ2=5.866,P<0.05,差异具有统计学意义.高分化28.5%,中分化39.2%,低分化48.9%;分化程度低,感染率高.平均秩H.pylori阳性为124.9,阴性145.2,P<0.05,故分化程度越低则H.pylori感染阳性率越高.分期方面,分期较早的Ⅰ期14.2%、Ⅱ期10.7%较分期较晚的Ⅲ期41.28%、Ⅳ期48.2%高;平均秩H.pylori阳性为164.9,阴性为127.6,P=0.00<0.05.故分期越晚则H.p y l o r i感染阳性率高.高侵袭性患者的阳性率为59.7%;低侵袭性为26.1%,卡方检验结果为χ2=21.025,P<0.05,两者差异有显著性.性别、年龄间差异无统计学意义.H.pylori14C-UBT值与AFP浓度的相关系数r=0.88,P=0.00<0.05;而其与HBV DNA拷贝数间的相关系数r=0.657,P=0.01<0.05,两者均呈正相关关系,差异均有统计学意义.结论:H.pylori感染与PHC发生、发展关系较密切.

AIM： To investigate the relationship between Helicobacter pylori（H. pylori） infection and primary hepatic carcinoma.METHODS： Clinical data for patients who were newly diagnosed with primary hepatic carcinoma and patients with non-cancer diseases treated at Guangxi Medical University Cancer Hospital from March 2010 to October 2013 were retrospectively analyzed to assess the relationship between H. pylori infection and primary hepatic carcinoma. Patients with primary hepatic carcinoma were further divided into two groups, one undergoing detection of HBV DNA copy number and H. pylori 14C-UBT, and the other undergoing the determination of alphafetal protein（AFP） concentrations and H. pylori 14C-UBT. The relationship among 14C-UBT value, HBV DNA copy number and AFP concentrations were assessed.RESULTS： The positive rate of H. pylori infection was significantly higher in primary hepatic carcinoma than in non-cancer diseases, in poorly differentiated primary hepatic carcinoma than in moderately and well differentiated carcinoma, in stage Ⅲ/Ⅳ carcinoma than in stage Ⅰ/Ⅱ, in highly invasive carcinoma than in minimally invasive, and in bile duct cell type than in other two types. Gender and age had no significant impact on the positive rate of H. pylori infection. 14C-UBT value was significantly positively correlated with AFP concentrations（r = 0.88） and HBV DNA copy number（r = 0.657）. CONCLUSION： H. pylori infection may be associated with the occurrence and development of primary hepatic carcinoma.