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慢性肝病成人的肝细胞癌预防和监测推荐

Author
Massimo Colombo, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
褚延魁, 主任医师

引言

慢性肝病是发生肝细胞癌(hepatocellular carcinoma, HCC)的主要危险因素[1]。预防或治疗肝病可降低HCC的风险。此外，使用现代影像学检测技术监测存在风险的患者可以发现小于2cm的早期肿瘤并描述其特征，这些肿瘤的预后可能优于更大的肿瘤。早期HCC有效治疗方法的发展对早期检测提供了额外的支持。 (参见“肝细胞癌治疗方法的概述”)

本专题将总结在慢性肝病患者中监测HCC的相关证据，并提供接受监测患者的选择、监测方法及证实存在HCC的其他检查方法的建议。下文提供的推荐与2005年美国肝病研究协会(American Association for the Study of Liver Diseases, AASLD)发表并于2010年更新的指南一致[2-4]。其他指南，包括2012年欧洲肝脏研究协会与欧洲癌症研究和治疗组织的指南[5]，以及2003年英国胃肠病学会的指南[6]，均与AASLD指南相似。

总体HCC监测和筛查的问题、HCC的治疗和HCC患者的预后将在别处讨论。 (参见“原发性肝细胞癌的临床特征和诊断”，关于‘筛查和监测’一节和“肝细胞癌治疗方法的概述”和“肝细胞癌的分期和预后因素”)

肝细胞癌的预防

HCC的唯一主要危险因素是任何病因引起的肝硬化。此外，HCC还与乙型肝炎病毒(hepatitis B virus, HBV)感染、丙型肝病毒(hepatitis C virus, HCV)感染、环境毒素暴露、遗传性血色病、糖尿病、超重、吸烟及大量饮酒等有关。预防HCC应着重于预防HBV和HCV感染、治疗适合接受治疗的病毒性肝炎患者、避免接触环境毒素、停止大量饮酒、控制体重，以及清除遗传性血色病患者体内过多的铁。 (参见“肝细胞癌的流行病学和病因学关联”，关于‘危险因素’一节)

肝硬化相关HCC — 大多数HCC患者存在基础肝硬化，旨在预防肝硬化进展的治疗将会降低发生HCC的风险。肝硬化患者发生HCC的风险不一，部分取决于肝硬化的病因(表 1)。 (参见“肝细胞癌的流行病学和病因学关联”，关于‘危险因素’一节)

                        

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