[肝胆速递] 乙肝或者丙肝感染人群中的肝癌相关危险因素

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乙肝或者丙肝感染人群中的肝癌相关危险因素
Risk factors for hepatocellular carcinoma in a cohort infected with hepatitis B or hepatitis C

[肝胆速递]：在乙肝丙肝感染人群中筛查肝癌时应注意年龄、男性等因素。

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06785.x/abstract

Abstract
Background and aim: 
The incidence of hepatocellular carcinoma (HCC) has increased in Australia in recent decades, a large and growing proportion of which occurs among a population chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). However, risk factors for HCC among these high-risk groups require further characterisation.

Methods: 
We conducted a population based cohort study using HBV and HCV cases notified to the New South Wales (NSW) Health Department between 2000 and 2007. These were linked to cause of death data, HIV/AIDS notifications and hospital records. Proportional hazards regression was used to identify significant risk factors for developing HCC.

Results: 
Two-hundred and forty-two and 339 HCC cases linked to HBV (n = 43,892) and HCV (n = 83,817) notifications, respectively. For both HBV and HCV groups, being male and increasing age were significantly associated with risk of HCC. Increasing comorbidity score indicated high risk while living outside urban areas was associated with lower risk. Hazard ratios for males were two to three times those of females. For both HBV and HCV groups, cirrhosis, alcoholic liver disease and the interaction between the two were associated with significantly and considerably elevated risk.

Conclusion: 
This large population-based study confirms known risk factors for HCC. The association with older age highlights the potential impact of HBV and HCV screening of at-risk groups and early clinical assessment. Additional research is required to evaluate the impact of improving antiviral therapy on HCC risk.

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摘要

背景及目的

近几十年来，肝细胞癌（HCC）在澳大利亚的发病率有所增长，在这些发病的人群当中，有相当大的一部分（并且这个数字还在增长）为慢性HBV（乙肝）或HCV（丙肝）病人。不过，这些高风险人群罹患HCC的风险因素需要进一步鉴定。

方法

我们以队列研究的方法，拟用新南威尔士州卫生部2000年到2007年的HBV及HCV病例，将这些病例与造成死亡的数据，艾滋病报告以及医院记录联系一起，运用相对危险回归法以确认HCC发展中的重要风险因素。

结果

分别有242例和339例HCC与HBV（n=43892）、HCV（n=83817）病例相关。对于HBV和HCV病例来说，男性、年龄增大都与HCC密切相关。合并发病率增长显示与高风险相关，而居住在郊区可以降低风险。男性的患病风险为女性的2-3倍。HBV及HCV群体，肝硬化，酒精肝以及合并HBV、HCV均显著提高风险。

结论

这个以较大人群为基础的研究证实了已知的HCC风险因素：年龄增长突出潜在风险（在危险群体HBV及HCV筛查以及早期临床评价中得出），仍需进一步研究以鉴定促进抗病毒治疗对于HCC风险因素的作用