573例原发性肝癌病因及临床特点分析*

目的 分析原发性肝癌（PLC）患者的临床特点，分析发病的相关致病因素。方法 选择2005年1月至2014年1月河北医科大学第三医院中西医结合肝病科经血清学、肝脏影像学检查明确诊断的PLC患者573例，回顾性分析发病年龄、性别、病因、家族史、个人史及临床特点。结果 PLC患者发病年龄为17~92（58.7±10.8）岁，其中79.4%于40~69岁发病，尤以50~69岁高发，占61.6%；男女之比为4.5：1；男性平均发病年龄为（57.4±10.3）岁，显著早于女性（64.5±11）岁，P<0.001）]；慢性HBV、HCV感染及酒精为主要的致病因素，单纯HBV感染、HBV感染合并酒精性肝病（ALD）、HCV感染和ALD所致的PLC依次为317例（55.3%）、154例（26.9%）、38例（6.6%）和22例（3.8%），其平均发病年龄依次为（58.6±10.6）岁、（54.3±8.4）岁、（67.0±7.8）岁和（58.4±11.4）岁，HBV感染合并ALD患者发病年龄显著低于其余各组（P<0.001）；491例（85.7%）PLC患者存在肝硬化，100例（21.2%）有HBV感染家族史, 仅53例（9.3%）有PLC家族史；在333例HBV感染相关性PLC患者中，240例 （72.1%）血清HBV DNA阳性；血清HBsAg、HBeAb、HBcAb阳性占57.4%；血清甲胎蛋白（AFP）升高者为394例（79.1%），其中大于400μg/L者197例（39.4%），7~400μg/L者196例（39.2%），105例（21.2%）正常。结论 HBV感染为PLC患者发病的主要病因，在HBV感染基础上长期饮酒是促使PLC发病的主要危险因素，肝硬化为PLC发病的主要病理基础。肝癌家族史、糖尿病、吸烟亦为PLC发生的危险因素。AFP作为诊断PLC的主要血清标志，其诊断价值正在减弱。

Etiology and clinical characteristics in 573 patients with primary liver cancer

Objective To investigate the etiology and clinical characteristics in patients with primary liver cancer（PLC）. Methods 573 patients with PLC，diagnosed by serology and hepatic imaging，were enrolled in this study from January 2005 to January 2014 in the Department of Traditional and Western Medical Hepatology，Third Hospital of Hebei Medical University，Shijiazhuang，China. Results The mean age of the patients was（58.7±10.8） years（range 17 to 91 years），of which 79.4% were 40~69 years，with the age of 50 to 69 years as the highest （61.6%）. The ratio of male to female patients was 4.5:1，and the average age in male patients was（57.4±10.3） years，significantly younger than that in female patients （64.5±11） years，P<0.001]；The prevalence of HBV infection，HBV infection with alcoholic liver disease （ALD），HCV infection and ALD in patients with PLC were 55.3%，26.9%，6.6% and 3.8%，respectively；The average ages of patients with HBV infection and ALD，ALD，HBV infection，and HCV infection were （54.3±8.4） years，（58.4±11.4） years，（58.6±10.6） years and （67.0±7.8）years，P<0.001]；85.7% of patient with PLC in our series had underlying liver cirrhosis；100（21.2%） and 53 （9.3%） patients had a family history of HBV infection and PLC；In 240 patients with HBV related PLC，serum HBV DNA was detected and the serum HBV DNA levels were observed greater than 1×104 IU/ml in 53.2% of them；The common models of serum HBV markers were HBsAg，anti-HBe，and anti-HBc positive in 57.4%；The serum α-fetoprotein（AFP） level was elevated in 79.1% of patients with PLC，and 39.6% were above 400μg/L，39.4% were 7~400μg/L，and 21.2% were normal. Conclusions HBV infection is the major risk factor for PLC，and alcohol consumption promotes PLC development in individuals with HBV infection. Serum AFP is the marker for PLC，but the diagnostic value needs further assessment.