乙型肝炎病毒相关性原发性肝癌的临床和病理特征

Clinical and Pathologic Features of Primary Hepatic Carcinoma Associated with Hepatitis B Virus

目的 为探讨乙型肝炎病毒 (HBV)相关性原发性肝癌 (PHC)的临床和病理特征。方法 经手术和病理证实的 2 0 0例PHC患者 ,依据病史、肝功能和乙肝五项标志的检测了解HBV感染史和感染模式 ,以及肝功能异常情况 ;分析肝组织病理学变化和手术所见 ,以探讨HBV相关性PHC的病理特征。结果 2 0 0例PHC患者中有 181例乙肝五项标志阳性 ,其总HBV感染率为90 5 %。以HBsAg、抗 -HBe和抗HBc的阳性率 ( 5 0 83 %)为最高 ,而HBsAg、HBeAg和抗 -HBc的阳性率仅为 4 97%。在PHC发生前 ,无HBV感染史和无症状HBV携带者分别占 61 3 3 %和 6 63 %。 8 2 9%的患者曾患肝炎治愈后无复发 ,有慢性乙肝和肝硬化病史及临床表现者仅分别占 2 2 10 %和 1 66%。约半数肝功能正常 ,异常者大都为轻度低蛋白血症 ,SB和ALT、AST轻～中度升高。肝组织病理特征如下 :肝细胞癌 (HCC)占 91 95 %,结节型、巨块型和小肝癌分别占 5 5 2 5 %、3 0 94%和 13 81%。多分布于肝右叶。静脉癌栓发生率为 12 71%。 86 3 2 %患者伴有肝硬化 ,多为活动期。结论 ⑴HBV与PHC关系密切 ,感染模式以HBsAg、抗 -HBe和抗 -HBc阳性为主。⑵HBV感染后肝脏病变隐匿进展。⑶多伴有活动性肝硬化。

Objective To investigate the clinical and pathologic features of primary hepatic carcinoma(PHC) associated with hepatitis B virus,HBV). Methods 200 cases of the patients with PHC were diagnosed by histopathologic examination and surgery. The history of HBV infection, its infective patterns and abnomal liver function were obtained from the medical history, and the tests of liver function and HBV five markers. The pathologic features of PHC associated with HBV were determined by analysis of histopathologic changes and views of surgery. Results The markers of HBV were positive in 181 out of 200 cases with PHC, and the positive rate of HBV infection was 90.5%. The postitive rate of HBsAg, anti-HBe and anti-HBc was the highest among the five markers of HBV (50.83%). The positive rate of HBsAg and HBeAg and anti-HBc was only 4.97%. The PHC patients without history of HBV infection and asymptomatic carriers of HBV accounted for 61.33% and 6.63%, respectively. The cases with cured hepatitis and no relapse accounted for 8.29%. The cases with chronic hepatitis B and with liver cirrhosis accounted for 22.10% and 1.66%, respectively. Liver functions were slightly abnomal in approximately one-half patients with PHC. Histopathologic features were as following: HCC accounted for 91.95%, and nodular type, macro-type and small hepatic carcinomas accounted for 55.25%, 30.94% and 13.81%,respectively. The distributions of PHC were mainly in right lobe of liver. The incidence of venous cancer embolism was 12.71%. The incidence of liver cirrhosis was 83.32%. Conclusions ⑴There was relationship between HBV and PHC. The main infective pattern of HBV was the positive HBsAg, anti-HBe and anti-HBc;⑵Pathologic lesion of liver was hidden after infection of HBV;⑶The incidence of active cirrhosis was high; and ⑷There were many pathologic features in patients with PHC associated with HBV.