PDF下载 ( 2056 KB)
肝细粒棘球蚴病与HBV/HCV感染、肝硬化、肝细胞癌共患病的临床观察
DOI: 10.3969/j.issn.1001-5256.2022.03.020
伦理学声明：本研究方案于2020年10月24日经由石河子大学医学院第一附属医院伦理委员会审批，批号：KJ2020-118-01，患者均签署知情同意书。
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突，特此声明。
作者贡献声明：张宏伟、林芷伊、彭心宇对研究的思路或设计有关键贡献；满洋、苗章、闫乐蓉、程萧、荆仁一、白蓉、黄平文参与了研究数据的获取分析及解释过程；满洋、张宏伟参与起草或修改文章关键内容。
Comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma
-
摘要:
目的 了解肝细粒棘球蚴病与HBV/HCV感染、肝硬化、肝细胞癌共患病状态，为进一步探讨肝细粒棘球蚴病对慢性HBV/HCV感染-肝硬化-肝细胞癌的影响奠定基础。 方法 回顾性分析2003年—2019年石河子大学医学院第一附属医院收治的401例肝细粒棘球蚴病患者资料，明确肝细粒棘球蚴病与慢性HBV/HCV感染、肝硬化、肝细胞癌的共患状态，进一步选取肝细粒棘球蚴病合并慢性HBV/HCV感染病例(共患病组)，匹配本院单纯慢性HBV/HCV感染患者为对照组，采用χ2检验、Fisher确切概率法，分析两组病毒感染状态、肝硬化、肝细胞癌的疾病构成。 结果 共患病组38例(9.5%)，合并HBV/HCV感染后肝硬化2例(0.5%)，合并HBV/HCV感染后肝细胞癌0例。共患病组的慢性HBV感染者中非活动性HBsAg携带患者占81%，HBeAg阳性CHB患者占9.5%，HBeAg阴性CHB患者占9.5%；单纯慢性HBV/HCV感染组的HBV感染者中非活动性HBsAg携带患者占43%，HBeAg阳性CHB患者占33%，HBeAg阴性CHB患者占19%，差异有统计学意义(P=0.033)；共患病组中HCV感染者的HCV RNA转阴率为73%，单纯慢性HBV/HCV感染组HCV感染者的HCV RNA转阴率为40%，差异有统计学意义(χ2=4.447，P=0.035)；共患病组肝硬化占5.2%，肝细胞癌为0，对照组肝硬化占18.4%，肝细胞癌占5.2%，共患病组较对照组肝硬化、肝细胞癌比例降低，差异有统计学意义(P=0.048)。 结论 肝细粒棘球蚴病合并HBV/HCV感染的肝硬化占比较单纯病毒性肝炎少，未发现合并HBV/HCV感染后肝细胞癌病例。肝细粒棘球蚴病对慢性HBV/HCV感染-肝硬化-肝细胞癌的影响需进一步多中心研究。 Abstract:Objective To investigate the comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma, and to lay a foundation for further research on the influence of hepatic cystic echinococcosis on HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma. Methods A retrospective analysis was performed for the data of 401 patients with hepatic cystic echinococcosis who were admitted to The First Affiliated Hospital of Shihezi University from 2003 to 2019, and the state of comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma was clarified. The patients with hepatic cystic echinococcosis and chronic HBV/HCV infection were selected as comorbidity group, and the patients with HBV/HCV infection alone were matched as control group. The chi-square test and the Fisher's exact test were used to analyze the state of viral infection and the disease composition of liver cirrhosis and hepatocellular carcinoma. Results Of all 401 patients, 38(9.5%) were included in the comorbidity group and 2(0.5%) had liver cirrhosis after HBV/HCV infection, while no patient had hepatocellular carcinoma after HBV/HCV infection. Among the patients with chronic hepatitis B virus infection in the comorbidity group, non-active HBsAg carriers accounted for 81%, HBeAg-positive chronic hepatitis B patients accounted for 9.5%, and HBeAg-negative chronic hepatitis B patients accounted for 9.5%; among the patients with hepatitis B virus infection in the control group, non-active HBsAg carriers accounted for 43%, HBeAg-positive chronic hepatitis B patients accounted for 33%, and HBeAg-negative chronic hepatitis B patients accounted for 19%, with a significant difference between the two groups (P=0.033). There was a significant difference in the HBV RNA clearance rate of the patients with HCV infection between the comorbidity group and the control group (χ2=4.447, P=0.035). In the comorbidity group, the patients with liver cirrhosis accounted for 5.2% and there were no patients with hepatocellular carcinoma, while in the control group, the patients with liver cirrhosis accounted for 18.4% and those with hepatocellular carcinoma accounted for 5.2%; the comorbidity group had significantly lower proportions than the control group (P=0.048). Conclusion The proportion of liver cirrhosis patients with hepatic cystic echinococcosis and HBV/HCV infection is lower than that of liver cirrhosis patients with viral hepatitis alone, and there are no cases of hepatocellular carcinoma after HBV/HCV infection. Further multicenter studies are needed to investigate the influence of hepatic cystic echinococcosis on chronic HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma. -
Key words:
- Echinococcosis, Hepatic /
- Hepatitis Viruses /
- Liver Cirrhosis /
- Carcinoma, Hepatocellular
-
表 1 肝包虫病对HBV/HCV感染状态及病程影响的比较
指标 共患病组(n=38) 单纯肝炎组(n=76) χ2值 P值 性别[例(%)] 0.476 0.490 男 26(68) 47(62) 女 12(32) 29(38) 年龄[例(%)] 0.121 0.728 < 35岁 6(16) 14(18) ≥35岁 32(84) 62(82) 肝炎病程[例(%)] 0.650 0.723 <10年 12(31) 19(25) 10~20年 20(53) 42(55) ＞20年 6(16) 15(20) 饮酒史[例(%)] 1.160 0.281 有 7(18) 21(28) 无 31(82) 55(72) 吸烟史[例(%)] 3.254 0.071 有 9(24) 31(41) 无 29(76) 45(59) 规律抗病毒治疗[例(%)] 3.109 0.078 有 2(5) 13(17) 无 36(95) 63(83) 慢性HBV感染[例(%)] 21(55) 42(55) 0.033 慢性HBV携带状态 0(0) 2(5) HBeAg阳性CHB 2(9.5) 14(33) 非活动性HBsAg携带 17(81) 18(43) HBeAg阴性CHB 2(9.5) 8(19) 慢性HCV感染[例(%)] 15(40) 30(40) 4.447 0.035 HCV RNA阳性 4(27) 18(60) HCV RNA转阴 11(73) 12(40) 慢性HBV、HCV共感染[例(%)] 2(5) 4(5) 1.000 HBeAg阴性CHB，HCV RNA阳性 1(50) 1(25) 非活动性HBsAg携带，HCV RNA阴性 1(50) 1(25) 非活动性HBsAg携带，HCV RNA阳性 0(0) 2(50) 病情进展[例(%)] 0.048 单纯HBV/HCV感染 36(95) 58(76) 合并肝硬化 2(5) 14(18) 合并肝癌 0(0) 4(5) 
下载: 导出CSV
表 2 肝包虫分型情况
包虫分型 共患病患者(n=38) 单纯肝包虫患者(n=363) 单囊型(CL、CE1) 6 81 多子囊型(CE2) 14 155 内囊塌陷型(CE3) 5 52 实变型(CE4) 6 44 钙化型(CE5) 7 31
下载: 导出CSV
-
[1] GAO Y, WU XW, LIU GS, et al. Clinical effect of surgery in treatment of calcified hepatic cystic echinococcosis[J]. J Clin Hepatol, 2020, 36(3): 616-619. DOI: 10.3969/j.issn.1001-5256.2020.03.029.高宇, 吴向未, 刘桂生, 等. 手术治疗钙化型肝细粒棘球蚴病的效果观察[J]. 临床肝胆病杂志, 2020, 36(3): 616-619. DOI: 10.3969/j.issn.1001-5256.2020.03.029. [2] HUANG D, LI R, QIU J, et al. Geographical environment factors and risk mapping of human cystic echinococcosis in western China[J]. Int J Environ Res Public Health, 2018, 15(8): 1729. DOI: 10.3390/ijerph15081729. [3] LIU J, LIANG W, JING W, et al. Countdown to 2030: Eliminating hepatitis B disease, China[J]. Bull World Health Organ, 2019, 97(3): 230-238. DOI: 10.2471/BLT.18.219469. [4] CHEN YS, LI L, CUI FQ, et al. A sero-epidemiological study on hepatitis C in China[J]. Chin J Epidemiol, 2011, 32(9): 888-891. DOI: 10.3760/cma.j.issn.0254-6450.2011.09.009.陈园生, 李黎, 崔富强, 等. 中国丙型肝炎血清流行病学研究[J]. 中华流行病学杂志, 2011, 32(9): 888-891. DOI: 10.3760/cma.j.issn.0254-6450.2011.09.009. [5] MYSORE KR, LEUNG DH. Hepatitis B and C[J]. Clin Liver Dis, 2018, 22(4): 703-722. DOI: 10.1016/j.cld.2018.06.002. [6] ZHENG X, LIU J, WU J, et al. Advances and challenges in immune control and functional cure of chronic hepatitis B[J]. J Clin Hepatol, 2020, 36(5): 961-964. DOI: 10.3969/j.issn.1001-5256.2020.05.001.郑昕, 刘嘉, 吴珺, 等. 免疫控制与慢性乙型肝炎功能性治愈的进展与挑战[J]. 临床肝胆病杂志, 2020, 36(5): 961-964. DOI: 10.3969/j.issn.1001-5256.2020.05.001. [7] CHEN C, GAO Q, LUO Y, et al. The immunotherapy with hMASP-2 DNA nanolipoplexes against echinococcosis in experimentally protoscolex-infected mice[J]. Acta Trop, 2020, 210: 105579. DOI: 10.1016/j.actatropica.2020.105579. [8] WANG ZY, LIU YH, ZHANG R, et al. Epidemiological characteristics of hepatitis B in China from 2004 to 2013[J]. Chin Gen Pract, 2017, 20(23): 2879-2883. DOI: 10.3969/j.issn.1007-9572.王祖煜, 刘熠赫, 张芮, 等. 2004-2013年中国乙型病毒性肝炎的流行病学特征研究[J]. 中国全科医学, 2017, 20(23): 2879-2883. DOI: 10.3969/j.issn.1007-9572. [9] Ministry of Health, The People's Republic of China. Diagnostic Criteria For Echinococcosis(WS257-2006)[S]. Beijing: People's Medical Publishing House, 2006.中华人民共和国卫生部. 包虫病诊断标准(WS257-2006)[S]. 北京: 人民卫生出版社, 2006. [10] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: A 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002. [11] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for hepatitis C: A 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1961-1979. DOI: 10.3969/j.issn.1001-5256.2015.12.003.中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1961-1979. DOI: 10.3969/j.issn.1001-5256.2015.12.003. [12] Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. [13] National Health and Family Planning Commission of the People's Republic of China. Diagnosis, management, and treatment of hepatocellular carcinoma (V2017)[J]. J Clin Hepatol, 2017, 33(8): 1419-1431. DOI: 10.3969/j.issn.1001-5256.2017.08.003.中华人民共和国国家卫生和计划生育委员会. 原发性肝癌诊疗规范(2017年版)[J]. 临床肝胆病杂志, 2017, 33(8): 1419-1431. DOI: 10.3969/j.issn.1001-5256.2017.08.003. [14] SOLOMON N, KACHANI M, ZEYHLE E, et al. The natural history of cystic echinococcosis in untreated and albendazole-treated patients[J]. Acta Trop, 2017, 171: 52-57. DOI: 10.1016/j.actatropica.2017.03.018. [15] Chinese Society of Hepatology, Chinese Medical Association. Strengthen prevention of chronic hepatitis B blocking liver cirrhosis and liver cancer[J]. Health Guide, 2020, 7: 14-15.中华医学会肝病学分会. 加强预防慢性乙肝阻截肝硬化和肝癌[J]. 健康指南, 2020, 7: 14-15. [16] LEVRERO M, ZUCMAN-ROSSI J. Mechanisms of HBV-induced hepatocellular carcinoma[J]. J Hepatol, 2016, 64(1 Suppl): S84, S101. DOI: 10.1016/j.jhep.2016.02.021. [17] GAO P, LUO YP, LI JF. Effects of hepatitis B virus on T lymphocytes and their subsets in chronic hepatitis B patients in different ALT states[J]. J Jilin Univ(Med Edit), 2020, 46(2): 359-364. DOI: 10.13481/j.1671-587x.20200225.高鹏, 雒艳萍, 李俊峰. 乙型肝炎病毒对不同ALT状态下慢性乙型肝炎患者T淋巴细胞及其亚群的影响[J]. 吉林大学学报(医学版), 2020, 46(2): 359-364. DOI: 10.13481/j.1671-587x.20200225. [18] ZHANG WL, LIU ZJ, GAN HZ, et al. Effect of viral load on serum inflammatory factors, immune function indexes and liver function indexes in patients with hepatitis B virus infection[J]. Clin J Med Offic, 2020, 48(7): 856-857. DOI: 10.16680/j.1671-3826.2020.07.44.张文良, 刘正金, 甘海忠, 等. 乙型肝炎病毒感染患者病毒载量对血清炎症因子、免疫功能指标及肝功能指标影响[J]. 临床军医杂志, 2020, 48(7): 856-857. DOI: 10.16680/j.1671-3826.2020.07.44. [19] SAXENA R, KAUR J. Th1/Th2 cytokines and their genotypes as predictors of hepatitis B virus related hepatocellular carcinoma[J]. World J Hepatol, 2015, 7(11): 1572-1580. DOI: 10.4254/wjh.v7.i11.1572. [20] LI H, ZHENG HW, CHEN H, et al. Hepatitis B virus particles preferably induce Kupffer cells to produce TGF-β1 over pro-inflammatory cytokines[J]. Dig Liver Dis, 2012, 44(4): 328-333. DOI: 10.1016/j.dld.2011.11.005. [21] LI TY, YANG Y, ZHOU G, et al. Immune suppression in chronic hepatitis B infection associated liver disease: A review[J]. World J Gastroenterol, 2019, 25(27): 3527-3537. DOI: 10.3748/wjg.v25.i27.3527. [22] DÍAZ Á. Immunology of cystic echinococcosis (hydatid disease)[J]. Br Med Bull, 2017, 124(1): 121-133. DOI: 10.1093/bmb/ldx033. [23] BERRIEL E, FREIRE T, CHIALE C, et al. Human hydatid cyst fluid-induced therapeutic anti-cancer immune responses via NK1.1+ cell activation in mice[J]. Cancer Immunol Immun, 2021, 70: 3617-3627. DOI: 10.1007/s00262-021-02948-x. 期刊类型引用(8)
1. 蒋丽莎，马洪升. 日归手术——中国日间手术的升华. 华西医学. 2022(02): 161-164 . 
百度学术2. 雷甜甜，梁鹏，马洪升，蒋丽莎. 四川大学华西医院日归手术管理实践. 广东医学. 2022(10): 1222-1228 . 百度学术3. 方宁波，陈伟力. 腹腔镜胆囊切除术日间手术围术期指标观察及患者延迟出院原因分析. 江西医药. 2022(10): 1524-1527 . 百度学术4. 刘力玮，郑亚民，刘东斌，王悦华，刘家峰，梁阔，江华，高崇崇，于志浩，徐大华. 日间腹腔镜胆囊切除术的可行性分析. 腹腔镜外科杂志. 2021(05): 359-362 . 百度学术5. 杨奕夫，黎柏峰，肖艳. 日间腹腔镜胆囊切除术质量控制的研究进展. 腹腔镜外科杂志. 2020(10): 796-798+800 . 百度学术6. 李航，赵礼金. 老年患者腹腔镜胆囊切除日间手术的安全性分析. 中国普通外科杂志. 2019(08): 1012-1017 . 百度学术7. 石鑫，秦琦瑜，刘维丽，胥静，王威. “三镜”联合治疗胆囊结石合并肝外胆管结石手术效果及安全性研究. 临床军医杂志. 2018(06): 710-712 . 百度学术8. 张少成，张亚辉，徐小梦. 年龄因素对上胆道疾病患者行腹腔镜胆囊切除术安全性的影响. 深圳中西医结合杂志. 2018(06): 184-186 . 百度学术其他类型引用(1)
-
百度学术
