原发性肝癌患者乙肝病毒感染模式及其与甲胎蛋白和肝功能的关系

目的 探讨原发性肝癌（primary hepatocellular carcinoma,PHC）患者乙型肝炎病毒（hepatitis B virus,HBV）感染模式与血清甲胎蛋白（AFP）及肝功能检查的关系.方法 采用化学发光免疫分析和ELISA法及用速率法生化分析分别检测116例PHC患者.进行了甲胎蛋白、乙型肝炎病毒五项标志物及肝功能总胆红素（TBILI）、谷丙转氨酶（ALT）、谷氨酰转肽酶（GGT）及碱性磷酸酶（ALP）血清检测.结果 116例PHC患者HBV总感染率为97.4%（113/116）.HBsAg阴性为8.62%（10/116）.PHC患者HBV血清标志物感染模式,以HBsAg、抗-HBe和抗HBc阳性模式（小三阳）感染类型最多.表明该模式的乙肝患者为原发性肝癌的高危人群.只有3例（2.6%）PHC无HBV感染标记.116例PHC患者AFP测定有29例（25.0%）结果阴性,87例测定结果阳性,阳性率达75.0%.116例PHC患者全部病例均行肝功能检查,原发性肝癌患者肝功能异常者有较高的发生率.肝功能损害各个指标浓度呈不同程度的增高.结论 HBV与PHC之间的关系非常明确,HBV感染不仅是肝癌发生的一个重要的危险因素,而且表明肝癌病人常伴有HBV的复制活跃.提示仍有25.0%PHC患者血清AFP检测结果呈阴性而易被漏诊.约有50%原发性肝癌患者肝功能损害.因此,积极预防和控制HBV感染流行,恰当治疗、保肝和护肝措施,是减少原发性肝癌发生的关键所在.

Relationship between HBV and AFP and liver function in PHC

Objective To explore the relationship between HBV infection modes and AFP and liver function in primary hepatocellular carcinoma (PHC). Methods The sera of 116 PHC patients were separately detected by chemiluminescence immunoassay (CLIA), ELISA and biochemical assay. The detective items included the blood serum AFP, five HBV markers, total bilirubin (TBILI), gammaglutam transferase (GGT), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). Results Of the 116 PHC patients, the total HBV infection rate was 97.4% (113/ 116), and the negative detection rate of HBsAg was 8. 6% (10/116). The infection mode of HBV serum markers in PHC patients was mostly HBsAg, ant-HBe, and anti-HBc positive mode, which amounted to 40. 8%. It indicated that hepatitis B patients of this mode were the high-risk crowd of PHC. Only 3 cases (2.6%) were without HBV infection markers. There were 29 cases with AFP negative in 116 PHC, about 25% , and positive 87, about 75%. The liver function was examined in all of PHC patients. The patients with abnormal live function had higher incidence in PHC. Each items of liver function presented damage in different degrees. Conclusions The relationship between HBV and PHC is of definitude. HBV infection is an important danger factor in the occurrence of HPC, and it indicates that PHC patients are often accompanied by active HBV replication. It also indicates that there are still 25% PHC patients with AFP negative who may fail to be diagnosed. About half PHC patients have liver damage. Therefore, to reduce PHC, the key point is to prevent and control HBV infection actively and treat it properly.