원발성 간암환자의 간염바이러스 감염양상 및 임상상 = The Prevalence of Hepatitis Virus infection and Clinical characteristics in Patients with Hepatocellular Carcinoma

다국어 초록 (Multilingual Abstract)

Background: Epidemiologic studies shows that Korea is one of the high incidence area of hepatocellular carcinoma (HCC) and the major etiologic factor is hepatitis B virus (HBV1. Recently developed assay for circulating antibodies against hepatitis C virus (HCV) suggests the possible etiologic role of HCV for HCC in a number of countries. To evaluate the role of hepatitis virus infection and clinical characteristics in Korean patients with HCC. We studied the positive rates of anti-HCV and HBsAg and analyzed clinical aspects in patients with HCC. Methods: Three hundred twenty six patients with HCC were included from May 1990 to June 1992. We analyzed the prevalence of hepatitis virus infection (B and C) and clinical aspects of the patients with HCC. Results: Among 326 patients examined, two hundred fifteen patients were found to be carriers of hepatitis B surface antigen (HBsAg) and hepatitis C antibodies (anti-HCV) were detected in 59 patients (18.1%). Two hundred nine patients were positive for HBsAg but negative for anti-HCV (64.1%, group B), Fifty four patients were negative for HBsAg but positive for anti-HCV (16.6%, group C). Fifty eight patients were negative for both HBsAg and anti-HCV (17.8%, group Non-BC), Five patients were positive for HBsAg and anti-HCV (1.5%, group BC). The mean age of patients in group C was significantly higher than that of patients with group B (65.3 versus 51.5 years, p<0.01). Coexistence of liver cirrhosis at diagnosis of HCC was found in 254 patients (77.6%) among 326 patients and there was no significant difference between groups. But according to Child-Pugh classification, percentage of class B and C were higher in group C than group B (68.5 vs 32.5%). By the gross appearance of HCC, nodular (single or multiple) type was more common in group C than group B (68.5 vs 32.5%). Alpha-fetoprotein levels greater than 400 ng/ml were found in 187 patients (57.4%) among 326 patients, 63.6% in group B, 51.9% in group C, 39.7% in group Non-BC. Another finding was that the past history of blood transfusion was noticed in only about 11% of anti-HCU positive patients. The detection rates of second generation enzyme immunoassay (EIA) for anti-HCV in HBsAg-negative HCC patients was slightly higher than that of the first generation EIA (50.7 vs 44. 49o). Conclusion: These data suggest that although hepatitis B virus is still the most important etiologic factor for HCC in Korea, HCV infection is an another important etiologic factor in HRsAg-negative HCC patients. Patients with HCV-related HCC tended to be older in age, more frequently associated advanced cirrhosis and nodular appearance in gross finding compared with HBV related HCC.