社区慢性乙型肝炎特定人群早期肝癌的追踪筛查研究

Follow-up screening of early liver cancer in specific population with chr onic hepatitis B in community

目的:对社区慢性乙型病毒性肝炎(乙型肝炎)特定人群开展早期肝癌的追踪筛查,为改善肝癌患者的预后提供参考依据。方法:收集2021年2月至12月就诊于深圳市龙华区人民医院及防保科登记在册的慢性乙型肝炎患者及其家族中其他慢性乙型肝炎患者的临床资料,随机抽取其中100例发病10年以上的患者作为筛查对象,制定计划每3个月追踪筛查一次,选定筛查项目﹝肝脏彩超、血甲胎蛋白(AFP)等﹞,统计分析早期肝癌的发病率等数据。结果:100例慢性乙型肝炎患者中,谷丙转氨酶(ALT)异常19例,AFP阳性9例,彩超异常31例;男女患者间AFP阳性率、ALT异常率、彩超异常率比较差异显著(P<0.05)。100例慢性乙型肝炎患者中检出肝癌患者3例,肝癌的年发病率为3.00%。通过对各检查方法的多因素logistic影响分析得出,ALT、AFP、彩超检查对早期肝癌均有较好的筛查效果;聚合酶链式反应(PCR)、彩超、AFP及肝CT/MR检查对于早期肝癌的筛查均具有较显著的敏感度、特异度,在社区慢性乙型肝炎特定人群的肝癌筛查中优势显著。结论:通过追踪筛查社区慢性乙型肝炎特定人群,能提高此类人群的防癌意识,提高肝癌的检出率,为后期肝癌的确诊和治疗提供一定的参考依据。

Objective:To conduct follow-up screening for early liver cancer in specific population of chronic viral hepatitis B(hepatitis B)in community,and to provide reference for improving the prognosis of patients with liver cancer.Method:Clinical data of chronic hepatitis B patients registered in Longhua District People’s Hospital and the Department of Prevention and Protection of Shenzhen City from February to December 2021 and other chronic hepatitis B patients in their families were collected.100 patients with more than 10 years of disease were randomly selected as screening objects,and a plan was made to track and screen them every 3 months.Screening items(liver color ultrasound,alpha-fetoprotein(AFP),etc.)were selected and the incidence of early liver cancer was statistically analyzed.Results:Among 100 patients with chronic hepatitis B,there were 19 cases of abnormal alanine aminotransferase(ALT),9 cases of positive AFP and 31 cases of abnormal color ultrasound.There were significant differences in the positive rate of AFP,abnormal rate of ALT and abnormal rate of color ultrasound among male and female patients(P<0.05).Among 100 patients with chronic hepatitis B,3 patients with liver cancer were detected,and the annual incidence of liver cancer was 3.00%.The results showed that ALT,AFP and color ultrasound had better screening effect on early hepatocellular carcinoma by logistic analysis.Polymerase chain reaction(PCR),color ultrasound,AFP and liver CT/MR Have significant sensitivity and specificity in screening for early liver cancer,and have significant advantages in screening for liver cancer in specific population with chronic hepatitis B in the community.Conclusion:By tracking and screening the specific population of chronic hepatitis B in the community,it can improve the awareness of cancer prevention and the detection rate of liver cancer,and provide certain reference for the diagnosis and treatment of liver cancer in th e later stage.