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目的:研究乙型肝炎表面抗原(HBsAg)携带者黄曲霉毒素(AF)暴露与原发性肝癌(肝癌)的相关性。方法:对148例感染乙型肝炎病毒(HBV)的肝癌高危险人群进行23年前瞻观察。结果:1)AF暴露人群肝癌人年发生率为2 763.96/10万(33/1 193.94),高于非暴露人群的1 168.45/10万人年(15/1 283.75),P=0.004,RR=2.37,95%CI:1.29～4.33;其他肿瘤两组间差异无统计学意义,P=0.597。2)AF暴露人群血检丙氨酸转氨酶(ALT)异常的次数及≥2次异常的人数分别占14.38%(161/1 120)及50.63%(40/1 120),高于非暴露人群的9.20%(102/1 109)及33.33%(23/1 109),P值分别为0.000和0.034;ALT异常人群尿中AFM1阳性率及AFM1≥10ng例数分别为75.71%(53/70)及68.57%(48/70),高于非暴露人群的33.33%(26/78)及29.49%(23/78),P值均为0.000。3)AF暴露人群外周血中AFP阳性的次数及≥2次阳性的人数分别占6.61%(74/1 120)及25.32%(20/1 120),高于非暴露人群的4.15%(46/1 109)及11.59%(8/1 109),P值分别为0.010和0.033。4)HBsAg携带者HCV感染率为2.03%(3/148),个人生活史、饮酒吸烟在AF暴露与非暴露组及肝癌与非肝癌对象中差异均无统计学意义,P>0.05。结论:AF暴露显著提高了HBV感染者的肝癌发生率,同时促进了HBV感染者肝功能损害。防治乙型肝炎和阻断AF污染是预防肝癌的有效途径。
Objective: To study the relationship between aflatoxin (AF) exposure and primary hepatocellular carcinoma (HCC) in carriers of hepatitis B surface antigen (HBsAg). Methods: A total of 148 cases of high-risk liver cancer patients with hepatitis B virus (HBV) were prospectively observed for 23 years. Results: 1) The annual incidence of liver cancer in AF-exposed population was 2 763.96 / 100 000 (33/1 193.94), higher than that of non-exposed population of 1 168.45 / 100 000 person-years (15/1 283.75), P = 0.004 = 2.37, 95% CI: 1.29 ~ 4.33; There was no significant difference between the two groups in other tumors, P = 0.597.2) The number of abnormalities of alanine aminotransferase (ALT) Accounting for 14.38% (161/1 120) and 50.63% (40/1 120), respectively, higher than those of non-exposed people (9.20% (102/1109) and 33.33% (23/1109), P values being 0.000 and 0.034; The positive rate of AFM1 and AFM1≥10ng in the abnormal ALT population were 75.71% (53/70) and 68.57% (48/70), respectively, which were higher than 33.33% (26/78) and 29.49% of the non-exposed population (23/78), both P values were 0.000.3) The number of AFP positive cases and the number of positive cases ≥2 in AF-exposed groups were 6.61% (74/1 120) and 25.32% (20/1 120) respectively, , 4.15% (46/1109) and 11.59% (8/1109), respectively, with a P value of 0.010 and 0.033.4, respectively) over the non-exposed population. The HCV infection rate of HBsAg carriers was 2.03% (3/148) There was no significant difference in personal life history and drinking and smoking between AF-exposed and non-exposed groups, and between HCC and non-HCC (P> 0.05). CONCLUSIONS: AF exposure significantly increased the incidence of liver cancer in HBV-infected individuals and at the same time promoted hepatic dysfunction in HBV-infected individuals. Prevention and treatment of hepatitis B and block AF contamination is an effective way to prevent liver cancer.