中山市小榄镇肝癌高发现场筛查评估及问题分析

目的 通过对高发区肝癌筛查现场的评估，了解筛查对象乙型肝炎表面抗原（hepatitis B surface antigen, HBsAg）阳性人群分布特征，并进一步分析筛查检出肝癌患者情况。方法 应用ELISA法检测血清HBsAg和甲胎蛋白（alpha-fetoprotein, AFP），B型超声进行腹部脏器检查。结果 （1）筛查人群HBsAg阳性率为15.7%（2 889/18 460），其中男性阳性率高于女性（P=0.000）。男女人群HBsAg阳性率均随年龄的增长呈降低趋势（P＜0.01）。（2）HBsAg阳性（肝癌高危）人群中初筛和随访分别检出肝癌11例和5例，早诊率分别为27.3%（3/11）和40%（2/5）。整个筛查队列两年共漏诊肝癌11例，其中4例源于高危人群自行退出随访，7例出自HBsAg阴性人群，漏诊的肝癌分别占相应人群总肝癌的20%（4/20）和25.9%（7/27）。（3）高危人群和一般人群组肝癌发病率分别为346.1/10万（20/5 778）和49.9/10万（37/74 084），前者发病率高于后者（P＜0.05）。高危人群组和一般人群组肝癌早诊率分别为30.0%（6/20）和8.1% （3/37），两者比较差异无统计学意义（P＞0.05）。高危人群组肝癌患者半年、1年和2年生存率分别高于一般人群组中肝癌患者（P＜0.05）。结论 在肝癌高发区进行筛查，了解人群HBsAg分布特征，筛选出高危人群，能及时发现肝癌患者，提高近期生存率。然而，HBsAg阴性人群和依从性差的高危人群中有一定的漏诊率，肝癌筛查的早诊率和生存率仍有待提高。

Situation and Problem on Screening of Liver Cancer in High-incidence Area of Xiaolan,Zhongshan City

Objective To evaluate liver cancer screening in high-incidence area, so as to analyze the distribution characteristics of positive hepatitis B surface antigen (HBsAg) among the population and screen the liver cancer patients further. Methods ELISA was used to detect the serum levels of HBsAg and alphafetoprotein( AFP). Ultrasonography was used to examine the organ of belly. Results (1) The positive rate of HBsAg was 15.7%(2889/18460). The male had higher positive rate of HBsAg than the female(P>0.01). The positive rate of HBsAg was negatively associated with age(P<0.01); (2) In first screening and follow-up, we detected 11 and 5 liver cancer patients in HBsAg positive population(high-risk population of liver cancer), respectively. The rates of early detection were 27.3%(3/11) and 40%(2/5), respectively. There were 11 liver cancer patients who missed diagnosis in the whole screening population for two years, four of them were high-risk population of liver cancer and exited the following-up, and the other seven patients were detected from HBsAg negative population. The rates of missed diagnosis were 20%(4/20) in the high-risk population and 25.9%(7/27) in the whole screening population, respectively; (3) In general population and high-risk population, the incidence of liver cancer were 49.9/105(37/74 084) and 346.1/105(20/5778) respectively (P<0.05); the rates of early detection were 8.1% (3/37) and 30.0% (6/20) , respectively(P>0.05). In general population, the survival rates of 0.5-, 1- and 2-year were lower than those in high-risk population(P<0.05). Conclusion Screening liver cancer in high-incidence area, we could understand the distribution of HBsAg, screen the high-risk population and detect liver cancer patients in time, so as to increase the recent survival rate of patients. However, the rates of missed diagnosis are high in HBsAg negative population and the highrisk population with poor compliance. The early detection and survival rates should be improved in liver cancer screening.