隐匿性乙肝与肝细胞肝癌关系的研究进展

Research progress in the relationship between occult hepatitis and hepatocellular carcinoma

摘要:

慢性乙肝是肝细胞肝癌（hepatocellular carcinoma，HCC）发生的主要危险因素已是公认的定论，那么隐匿性乙肝（occult hepatitis B virus infection，OBI）与HCC的相关性如何，却尚有争议。此文综合国内外临床和动物研究结果，总结出：OBI是HCC发生的重要危险因素。OBI保留有显性乙型肝炎病毒（hepatitis B virus，HBV）感染相同的致癌机制，如整合进宿主基因组，顺式激活相关基因或合成蛋白后反式作用于基因组或相关蛋白质，如合成乙肝病毒X蛋白（hepatitis B virus X antigen，HBX）、前S蛋白和乙肝表面抗原（hepatitis B surface antigen，HBsAg），这些蛋白可使肝细胞发生转化，影响信号通路，使细胞增殖、凋亡失衡。其次，持续存在的低载量病毒可导致轻微但持续的炎症坏死，肝细胞循环坏死、再生，加速肝硬化进程，最终导致HCC。最后，病毒突变及甲基化修饰在HCC发生中也有重要作用。

Abstract:

It’s certain that chronic hepatitis B is a main risk factor for hepatocellular carcinoma（HCC）. However，it’s uncertain whether occult hepatitis B virus infection（OBI） can result in HCC. We draw the conclusion that OBI is an important risk factor for HCC after reviewing literature at home and abroad. OBI maintains the same carcinogenic mechanisms as overt hepatitis B virus（HBV） infection：for example it also can cis-activate genome by integrating into the host genome，or trans-act to genome/protein by synthe－sising hepatitis B virus X antigen，preS，and hepatitis B surface antigen，which can impact signal path and induce the imbalance be－tween proliferation and apotosis. Secondly，the persistence of low level of HBV can induce slight and continuous necro-inflammation. It’s a cycle of necrosis and regeneration，which can lead to cirrhosis and HCC. Finally，mutation and methylation also play important roles in HCC.