乙型病毒性肝炎患者发展成肝癌的临床演变特征研究

张玲霞; 王永怡

Abstract

张玲霞,王永怡.乙型病毒性肝炎患者发展成肝癌的临床演变特征研究[J].Chinese journal of Epidemiology,1993,14(6):334-337

乙型病毒性肝炎患者发展成肝癌的临床演变特征研究

The Study on Clinical Characteristics of the Development of Primary Hepatocyte Carcinoma Induced by Hepatitis B

Received:January 20, 1993 Revised:February 22, 1993

DOI：

KeyWord: 乙型病毒性肝炎肿瘤

English Key Word: HBV Liver neoplasms

FundProject:

Author Name	Affiliation
Zhang Linxia	No.302 Hospital, Beijing 100039
Wang Yongyi	No.302 Hospital, Beijing 100039

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Abstract:

采用统计学方法对38例乙型肝炎患者发展成肝癌的临床演变特点进行临床流行病学研究。发现患乙型病毒性肝炎的,特别是男患者,血清ALT和Bil波动反复或持续异常4年以上;血清蛋白数质量趋向恶化:A/G<1.5、白蛋白<3.5g/L、蛋白电泳中γ球蛋白>24%:血小板计数<5万/mm³:血沉持续>20mm/h:γ-GT/ALT>1.5:AKP>170μ/L:αFP>20ng/ml后仍逐步增高,HBVM持续阳性,在抗-HBe转阳后仍伴有抗-HBc IgM持续阳性:同时发现食道静脉曲张等肝硬变综合征象者,应定期随访其αFP、B超和上述化验指标。必要时作CT、磁共振、肝动脉造影等特异检查以早期发现原发性肝细胞癌。

English Abstract:

This article reports the clinical characteristics of 38 cases of patients with hepatitis B (HB) which developed into primary hepatocyte carcinoma (PHC), during a period of observation for 2~28 years (average 11.4 years). These patients were admitted repeatedly for 2 to 12 times (average 3.4 times).
The clinical characteristics of the development of the symptoms in these patients were as follows:
1. Liver function fluctuated again and again. Ninty percent of these patients with HB developed liver cirrhosis (LC). Subsequently they developed into PHC.
2. HBV markers were positive over a long period of observation. During the phases of LC and PHC. the rates of positive anti-HBe were 23.5% and 54.5%, respectively (P<0.05). Comparing with anti-HBe, the rate of positive HBeAg was lower.
3. During the phase of HB, 21.0% of these patients had elevated αFP (mean titer 80.0ng/ml). During the phase of PHC; 65.8% of the patients had abnormal αFP (mean titer 635.9 ng/ml) (P<0.01).
Sustained high level of γ-GT and the ratio of γ-GT/ALT higher than 1.5 were dangerous signals (P<0.05).
The level of ALP in these patients with HB was below 170u/L. But 50% of them had high level of ALP when thay developed into PHC.
During the phase of LC these patients were detected regularly with ultrasonic waves.

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