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

满洋; 林芷伊; 苗章; 闫乐蓉; 程萧; 荆仁一; 白蓉; 黄平文; 张宏伟; 彭心宇

doi:10.3969/j.issn.1001-5256.2022.03.020

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

满洋¹,
林芷伊^2a,
苗章¹,
闫乐蓉¹,
程萧¹,
荆仁一¹,
白蓉¹,
黄平文¹,
张宏伟^{2b, 3, , ,},
彭心宇^2b

1.
石河子大学医学院，新疆石河子 832000
2a.
石河子大学医学院第一附属医院肿瘤内科，新疆石河子 832000
2b.
石河子大学医学院第一附属医院肝胆外科，新疆石河子 832000
3.
国家卫生健康委中亚高发病防治重点实验室，新疆石河子 832000

基金项目:

国家自然科学基金 (81860363);

湖北陈孝平科技发展基金 (CXPJJH11900001-2019313);

中国医学科学院中央级公益性科研院所基本科研业务费专项资金 (2020-PT330-003)

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。

详细信息

通信作者:
张宏伟，E-mail: zhw0108@163.com

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出版历程
- 收稿日期: 2021-08-23
- 录用日期: 2021-11-30
- 出版日期: 2022-03-20

Comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma

1.
Shihezi University School of Medicine, Shihezi, Xinjiang 832000, China
2a.
Department of Oncology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832000, China
2b.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832000, China
3.
NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Shihezi, Xinjiang 832000, China

Research funding:

National Natural Science Foundation of China (81860363);

Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei province (CXPJJH11900001-2019313);

Non-profit Central Research lnstitute Fund of Chinese Academy of Medical Sciences (2020-PT330-003)

More Information

Corresponding author: ZHANG Hongwei, zhw0108@163.com(ORCID: 0000-0002-3505-5804)

摘要

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。
- 棘球蚴病, 肝 /
- 肝炎病毒 /
- 肝硬化 /
- 癌, 肝细胞
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.
- Echinococcosis, Hepatic /
- Hepatitis Viruses /
- Liver Cirrhosis /
- Carcinoma, Hepatocellular

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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)

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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

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