广西肝癌、鼻咽癌高危人群的建立

发布时间：2018-06-29 23:32

本文选题：乙肝病毒 + EB病毒　；参考：《广西医科大学》2010年硕士论文

【摘要】： 背景：广西是原发性肝癌(以下简称肝癌)(primary liver carcinma,PLC)和鼻咽癌(Nasopharyngeal cancer, NPC)的高发病区。早期发现并早期治疗的病人,具有较高的5年生存率。大量的研究证实在肝癌、鼻咽癌高发区的筛查中,乙肝表面抗原和核心抗体及EB病毒相关抗体作为初筛指标确定危险人群是可靠的。对乙肝表面抗原和核心抗体均阳性者进一步检查血清甲胎蛋白(AFP)和肝脏B超；对EB病毒(Epstein-Barr virus)抗体(IgA/VCA)阳性者进一步进行血清学及鼻咽镜检查。对于AFP和／或肝脏B超检查以及鼻咽镜检查异常者要定期复查,并结合其他临床检查可以尽早作出诊断和治疗。因此,可以用乙肝表面抗原和核心抗体作为人群筛选和肝癌高危人群确立,用EB病毒抗体检测作为人群筛选和鼻咽癌高危人群确立的手段。在30-59岁的病毒阳性的高危人群中行定期检查会取得更好早诊效果。在高危人群中进行追踪检查能减少人力、物力等的支出,取得更好的社会经济效益。目的：1.在肝癌、鼻咽癌高危区人群进行相关病毒的血清学筛查,以建立其高危人群,并进行肝癌、鼻咽癌的风险预测。2.探讨病毒感染与性别、年龄的关系,为后期癌症的早诊早治打好基础。资料及方法：(1)于2009年4月～2009年12月通过检测血清乙肝两对半及EB病毒抗体(IgA/VCA),建立1104人的乙肝表面抗原和核心抗体均阳性的广西肝癌高危人群和418人的EB病毒抗体(IgA/VCA)阳性的鼻咽癌高危人群。(2)对建立的乙肝表面抗原阳性及核心抗体阳性的高危人群采集其外周血,进行肝功、AFP检测及两对半复查和B超检查；对EB病毒抗体(IgA/VCA)阳性的高危人群进行鼻咽镜检查；所有阳性人群建立登记表。(3)对于病毒阳性的高危人群,复查发现癌症的患者给予治疗指导,其他高危人群进行定期随访。(4)通过队列研究的结果评估该地区人群病毒阳性率,依此分析高危人群特点。结果：(1)在广西苍梧半年多的筛查,共筛查了目标人群中符合要求者共7711人,其中男性3677人,女性4034人。(2)7711人中乙肝表面抗原阳性和核心抗体阳性的肝癌高危人群1104人,男性595人,女性509人,阳性率14.32%,其中男性的阳性率16.18%,女性的阳性率12.62%。男女阳性率差异有统计学意义(P0.05)。(3)7711人中有6678人(男性3193人,女性3485人)测定了EB病毒IgA/VCA抗体,其中阳性418人,阳性中男性为189例,女性为229例,阳性率6.26%,其中男性的阳性率为5.92%,女性中的性率为6.57%,男女阳性率差异无统计学意义(P0.05)；(4)6678人中,乙肝表面抗原和IgA/VCA抗体同时阳性者48人,其中女性25人,男性23人。双阳性率为0.62%。(5)进行年龄分段后,50～59岁组的表面抗原阳性人群人数低于30岁～39岁和40岁～49岁组(P0.05),而30岁～39岁与40岁～49岁组之间表面抗原阳性人群人数无统计学差异(P0.05)；30岁～39岁组的表面抗原阳性人群中男性人数高于女性(P0.05),而40岁～49岁组和50～59岁组的表面抗原阳性人群中男性和女性的人数差异无统计学意义(P0.05)。50～59岁组的EB病毒阳性者人数高于30岁～39岁和40岁～49岁组(P0.05),而30岁～39岁与40岁～49岁组之间EB病毒阳性者人数差异无统计学意义(P0.05)。30岁～39岁组的EB病毒阳性人群中女性人数高于男性(P0.05),而40岁～49岁组和50-59岁组的EB病毒阳性人群中男性和女性的人数差异无统计学意义(P0.05)。(6)复查时,参加复查的阳性人群为691人,检测肝功异常者63人,其中男性19人,女性44人。检测出AFP阳性者26人,阳性率为3.76%。检查确诊鼻咽癌9例,B超检查肝异常84例。肝功异常并且B超检查异常者14人。结论：在苍梧筛查的适龄人群中,乙肝感染的阳性率为14.32%,乙肝感染与性别及年龄之间的关联性有显著的统计学意义,年龄在30～49岁的感染危险性相对更高,男性感染的危险性高于女性；EB病毒的感染的阳性率为6.26%,EB病毒感染的危险性在50～59岁人群中更高,感染EB病毒的性别差异无显著的统计学意义。这些结果部分验证了前人的研究,为以后的肝癌、鼻咽癌早诊早治提供现实依据。
[Abstract]:Background: Guangxi is a high incidence area of primary liver cancer (hereinafter referred to as primary liver carcinma, PLC) and nasopharyngeal carcinoma (Nasopharyngeal cancer, NPC). Early detection and early treatment have a high 5 year survival rate. A large number of studies have proved that hepatitis B surface antigen and core antibody in the screening of HCC and nasopharyngeal carcinoma high incidence area The EB virus related antibodies are reliable for determining the risk population as a screening index. The patients with positive hepatitis B surface antigen and core antibody are further examined for serum alpha fetoprotein (AFP) and liver B ultrasound, and further serological and nasopharyngeal examination for EB virus (Epstein-Barr virus) antibody (IgA/VCA) positive persons. For AFP and / or liver B Patients with abnormal examination and nasopharynx should be rechecked regularly and can be diagnosed and treated as early as possible with other clinical tests. Therefore, hepatitis B surface antigen and core antibody can be used as population screening and high risk population of liver cancer. EB virus antibody detection is used as a means of screening for population and high-risk group of nasopharyngeal carcinoma. 30-5 A 9 year old virus - positive group of high-risk groups can achieve better early diagnosis results. Tracking in high-risk groups can reduce expenditure on manpower and material resources and achieve better social and economic benefits.
Objective: 1. serological screening of related viruses in high-risk areas of liver cancer and nasopharyngeal carcinoma was conducted to establish high risk population, and to carry out liver cancer, and to predict the risk of nasopharyngeal carcinoma by.2. to explore the relationship between virus infection and sex and age, and to lay a foundation for early diagnosis and early treatment of cancer.
Data and methods: (1) from April 2009 to December 2009, by detecting serum hepatitis B two half and EB virus antibody (IgA/VCA), the high risk population of liver cancer in Guangxi and 418 people of EB virus antibody (IgA/VCA) positive were established in 1104 human hepatitis B surface antigen and core antibody. (2) the hepatitis B surface antigen Yang was established. The high risk population of sex and core antibody positive was collected from its peripheral blood, liver function, AFP test and two half reexamination and B ultrasound examination; nasopharyngoscopy was carried out on the high-risk group of EB virus antibody (IgA/VCA) positive; all positive people set up a registration form. (3) for the high risk population of the virus positive, the treatment of patients with cancer was reviewed. Regular follow-up visits were conducted to other high-risk groups. (4) the positive rate of virus in the area was assessed by cohort study, and the characteristics of high-risk groups were analyzed.
Results: (1) for more than half a year in Cangwu, Guangxi, 7711 people were screened in the target population, including 3677 men and 4034 women. (2) 7711 people with HBsAg positive and core antibody positive were 1104, 595 male, 509 female, and 14.32% positive rate, among which the positive rate of male was 16.18%, female The positive rate of positive rate of 12.62%. was statistically significant (P0.05). (3) 6678 of the 7711 people (3193 men and 3485 women) had measured the IgA/VCA antibody of EB virus, of which 418 were positive, 189 in male, 229 in the female, and 6.26% in the positive rate. The positive rate of male was 5.92%, the sex rate was 6.57% in women and the positive rate of men and women. The difference was not statistically significant (P0.05); (4) of the 6678 people, 48 people were positive for hepatitis B surface antigen and IgA/VCA antibody, including 25 women and 23 male. The double positive rate was 0.62%. (5), and the number of surface antigen positive groups in 50~59 year old group was lower than 30 to 39 years and 40 years to 49 years old (P0.05), and 30 years to 39 years and 40 years old. There was no significant difference in the number of surface antigen positive groups among the 9 years old group (P0.05); the number of men in the group of 30 to 39 years old was higher than that of women (P0.05), but there was no significant difference in the number of men and women in the group of 40 to 49 years old and 50~59 years old in the group of surface antigen positive (P0.05) EB virus Yang from the group of.50 to 59 years. The number of sex persons is higher than that of 30 to 39 years and 40 to 49 years (P0.05), while the number of EB virus positive persons between 30 to 39 years and 40 to 49 years old is not statistically significant (P0.05), the number of women in the EB virus positive group from.30 years to 39 years old is higher than that of men (P0.05), while the male and female of the EB virus positive group of 40 years to 49 years and 50-59 years old group are male and female. There was no significant difference in the number of sex differences (P0.05). (6) at the time of reexamination, 691 were positive in the reexamination and 63 were detected with abnormal liver function, of which 19 were male and 44 in women. 26 of the positive patients were detected, the positive rate was 9 cases of nasopharyngeal carcinoma diagnosed by 3.76%. examination, 84 cases of B-ultrasound examination, abnormal liver function and 14 patients with abnormal B ultrasound examination.
Conclusion: the positive rate of hepatitis B infection was 14.32% in the population screened in Cangwu. The correlation between HBV infection and sex and age was statistically significant. The risk of infection was higher in 30~49 years, and the risk of male infection was higher than that of women; the positive rate of EB infection was 6.26%, EB virus infection. The risk is higher among the 50~59 years old, and there is no significant statistical significance in the sex difference of EB virus. These results partly verify the previous study and provide a practical basis for the early diagnosis and treatment of nasopharyngeal carcinoma.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R735.7;R739.63

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