乙型及丙型肝炎患者发生肝细胞癌的风险预测:REVEAL-HBV/HCV研究的回顾

杨怀壹; 李美璇; 陈建仁

乙型及丙型肝炎患者发生肝细胞癌的风险预测:REVEAL-HBV/HCV研究的回顾

1. 中央研究院基因体研究中心
2. 中国医药大学附设医院分子与基因体流行病学研究中心
3. 国立台湾大学流行病学研究所

详细信息

中图分类号: R512.6
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出版历程
- 收稿日期: 2010-11-24
- 出版日期: 2011-04-20

Prediction of hepatocellular carcinoma risk in chronic hepatitis B and C:review of findings in REVEAL-HBV/HCV study

摘要

摘要: 乙型肝炎病毒（HBV）及丙型肝炎病毒（HCV）的慢性感染是肝细胞癌（HCC）的主要致病原因。全球约有3亿5千万人为HBV的慢性感染者;HCV慢性感染者则有2亿人。全球每年约有50万人死于乙型肝炎引起的HCC,另有25万人死于丙型肝炎引起的HCC。乙型肝炎慢性感染者,其血中HBV DNA及ALT持续处于高水平是HCC最重要的预测因子。其他的危险因子还包括HBV C基因型、HBV基础核心促进子A1762T/G1764A双突变、男性、老年、肝癌家族史、酗酒习惯、以及与HCV或人类免疫不全病毒的合并感染等。根据REVEAL-HBV研究的资料,我们发展出简单易用的列线图,可利用非侵入性的临床特征准确地预测慢性乙型肝炎患者发生HCC的风险。丙型肝炎慢性感染患者发生HCC最重要的预测因子包括高血中HCV RNA水平、高ALT水平、HCV基因型以及老年等。REVEAL-HCV研究案例中,与HCV RNA水平低于检测范围且低ALT水平者相比,HCV RNA可测得、高ALT水平且感染第一型病毒的案例具有最高的HCC发生风险,其多变项调整后的风险比值（95%CI）为21.87（5.09～93.95）,这些发...
- 癌,肝细胞 /
- 肝炎,乙型,慢性 /
- 肝炎,丙型,慢性
Abstract: Both hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of hepatocellular carcinoma (HCC) .An estimated 350 million people worldwide are living with chronic HBV infection, and 200 million with chronic HCV infection.Each year, an estimated 500 000 people die of HCC caused by chronic HBV infection, and another 200 000 HCC cases caused by chronic HCV infection.The most important predictors of HCC risk in persons who have chronic HBV infection are persistently elevated serum levels of HBV DNA and alanine aminotransferase (ALT) .Other HCC risk predictors for chronic hepatitis B patients include HBV genotype C infection, HBV basal core promoter A1762T/G1764A mutants, male sex, older age, family HCC history, habitual alcohol consumption, and co-infection with HCV or HIV.Based on the dataset of REVEAL-HBV study, easy-to-use nomograms using noninvasive clinical characteristics have been developed for accurate prediction of hepatocellular carcinoma risk in patients with chronic hepatitis B.The most important predictors of HCC risk in persons who have chronic HCV infection include elevated serum levels of HCV RNA and ALT, HCV genotype and older age.In the REVEAL-HCV study, participants with detectable HCV RNA level, elevated serum ALT levels and genotype 1 HCV infection had the highest risk of hepatocellular carcinoma showing a multivariate-adjusted hazard ratio (95 percent confidence interval) of 21.87 (5.09-93.95) , compared with those with undetectable HCV RNA level and low serum ALT levels as the referent group.These findings have strong implications for the management of chronic hepatitis C.
- carcinoma /
- hepatocellular /
- hepatitis B

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