丙肝病毒性肝硬化发展为肝细胞癌的高危因素----百济新特药房肝病专科

　　丙型肝炎病毒（HCV）感染所致肝硬化可发展为肝细胞癌。意大利Bruno等学者的一项前瞻性研究显示，感染基因1型HCV是肝硬化患者发生肝细胞癌的高危因素。

　　研究自1989年1月至1990年12月共纳入163例HCV感染所致的肝硬化患者，其中104例患者感染基因1b型HCV，52例感染2a/c型HCV。患者每6个月接受1次超声检查，以监测肝细胞癌的发生，应用Cox回归分析评价发生肝细胞癌的独立危险因素。

　　结果显示，经过平均10.7年的随访后，44例基因1b型HCV感染者发生肝细胞癌，10例基因2a/c型HCV感染者发生肝细胞癌（P=0.0001）。多因素分析显示，1b型HCV感染是发生肝细胞癌的独立危险因素。发生肝细胞癌的其他可预测因素有食管静脉曲张、男性、年龄超过60岁等。

　　研究者认为，1b型HCV感染易引起肝细胞癌，此型肝硬化患者应接受严密监测以发现早期癌变。

Hepatology. 2007 Nov;46(5):1350-6.

Hepatitis C virus genotype 1b as a major risk factor associated with hepatocellular carcinoma in patients with cirrhosis: a seventeen-year prospective cohort study.

Bruno S, Crosignani A, Maisonneuve P, Rossi S, Silini E, Mondelli MU.

Liver Unit, Department of Medicine, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy.

Hepatocellular carcinoma (HCC) is the most frequent cause of death in patients with hepatitis C virus (HCV)-induced cirrhosis. Despite a number of studies in different populations worldwide suggesting an association between HCV genotype 1 and the risk of HCC, no consensus has emerged yet on this matter, which is still controversial. In an attempt to clarify this issue, a prospective study of 163 consecutive HCV-positive patients with cirrhosis, who were enrolled between January 1989 and December 1990, was carried out. HCC occurrence was detected by ultrasound surveillance every 6 months. Independent predictors of HCC were assessed with a Cox regression analysis. After a median follow-up of 10.7 years, 44 [4.26/100/year, confidence interval (CI) = 3.11-5.68/100/year] of 104 patients infected with genotype 1b developed HCC versus 10 (1.69/100/year, CI = 0.82-3.09/100/year) of 52 patients infected with genotype 2a/c (P = 0.0001). Multivariate analysis showed that HCV genotype 1b was independently associated with HCC development [hazard ratio (HR) = 3.02, 95% CI = 1.40-6.53]. Other predictors of HCC were esophageal varices (HR = 2.15, 95% CI = 1.03-4.47), male gender (HR = 2.12, 95% CI = 1.10-4.11), and age over 60 years (HR = 5.96, 95% CI = 1.23-28.8). Conclusion: HCV genotype 1b is associated with a statistically significant higher risk of developing HCC. Patients with cirrhosis that are infected with this genotype require more intensive surveillance for the early detection and aggressive management of neoplasia.