【摘要】 目的　研究定期随访乙型肝炎病毒表面抗原 (HBsAg)携带者队列在肝癌发生中的病因学和临床意义。方法　在肝癌高发区 ,对HBsAg携带的 744人和相应的HBsAg阴性的 895人进行了 8年 3个月的前瞻性随访观察 ,同时建立血清库和进行详细的个人史调查。结果　 (1)HBsAg阳性组年平均肝癌发生率为 177 2 9/10万 ,高于HBsAg阴性组的 6 9 5 3/10万 ,相对危险度为 16 93,两组差异有非常显著意义 (P <0 .0 1)。其他肿瘤两组间差异无显著意义 (P >0 0 5 )。 (2 )个人史调查结果提示 ,发生肝炎到诊断肝癌的平均时间为 14 5年 ,中位时间 13年 ;肝硬化到诊断肝癌的平均时间为 6 4年 ,中位时间 5 5年。 (3)肝癌患者较差的经济状况 ,长期饮酒、吸烟 ,曾患肝病与慢性胃肠道疾病以及肝癌家属史均高于非肝癌组 (P <0 0 0 1) ,其他的个人嗜好、生活史、疾病史及家属史两组间差异无显著意义 (P >0 0 5 )。 (4)前瞻队列中发现的肝癌患者手术切除率 (16 44 % )及 1年生存率 (31 5 1% )均明显高于当地就诊肝癌患者 (分别为 8 7%、9 7% ,P <0 0 0 1)。结论　乙型肝炎病毒与肝癌发生密切相关 ;男性、年龄在 2 0～ 6 0岁之间、HBsAg携带及 /或有肝病史、家属肝癌史者 ,是肝癌的高危险人群。用甲胎蛋白测定结合B型超声检查定期随更多还原

【Abstract】 Objective To investigate the clinical and etiological significance of regular follow up study of cohort of HBsAg carriers in diagnosis and treatment of primary hepatic cancer (PHC). Methods A prospective follow up study lasting 8 years and 3 months was conducted among 744 HBsAg positive persons and 895 HBsAg negative persons in Qidong, Jiangsu Province, a high incidence area of PHC. A serum store was established. Survey of detailed individual history was made. Results (1) The year incidence rate of PHC was significantly higher in the HBsAg group (177.29/100,000) than in the HBsAg group (69.53/100,000, RR =16.93) ( P <0.01). There was no significance difference in the incidence rates of other tumors between these two groups ( P >0.05). (2) The average time between the onset of hepatitis and the diagnosis of PHC was 14.5 years with a median time of 13 years. The average time between the diagnosis of cirrhosis and the diagnosis of PHC was 6.4 years with a median time of 5.5.year. (3) Bad economic condition, longer history of drinking, longer smoking history, history of hepatitis and chronic gastrointestinal diseases, and family of PHC could be found more frequently in the PHC group than in the non PHC group ( P <0.001). There was no difference in other personal habit, personal history, disease history, and family hirsute between these two groups ( P >0.05). (4) The tumor resection rate (16.44%) and one year survival rate (31.51%) were significantly higher among the PHC patients in the prospective cohort than those in the PHC patients diagnosed and treated individually in local hospitals (8 7% and 9 7% respectively, P <0 01). Conclusion HBV is closely correlated with PHC. Males, persons aged between 20 and 60, HBsAg positive persons and /or persons with hepatitis history and family hepatitis history are high risk population for PHC. Regular follow up of these populations by AFP examination combined with B ultrasonography contributes to early diagnosis of PHC and significantly improves the curative effect.更多还原