Clinical Research On The Association Between Hepatitis Viruses Infection And Extra-hepatic Malignancies

Part Ⅰ:Trends about spectrum of liver diseasesObjective:To analyze the changing trends for spectrum of liver diseases of patients with hospitalization and to know about whether trends of patients with viral hepatitis have changed in our hospital.Methods:All patients admitted from Jan 2006 to Dec 2014 in the department of infectious diseases of the First Affiliated Hospital with Nanjing Medical University were enrolled.We did a retrospective analysis and distinguished patients with liver diseases by etiology and chose the first diagnosis of discharge for patients.We analyzed percentage rate of main etiologies,types of viral hepatitis,HBV distribution in viral hepatitis and different age groups for HBV.Results:During the consecutive nine years,the percentage rate of patients with liver diseases decreased obviously and the number of patients with liver diseases increased gradually.For etiology in liver diseases,viral hepatitis,drug-induced liver injury,autoimmune liver disease,alcoholic live disease and non-alcoholic fat liver disease ranked the top five,and the percentage rate was 62.61%,10.70%,4.96%,3.18%and 1.90%respectively.The percentage rate of viral hepatitis went down,however,percentage rates of drug-induced liver injury and autoimmune liver disease went up significantly.For patients with viral hepatitis,hepatitis B,C and E viruses occupied the top three reason,and percentage rate of hepatitis B virus was 70%or so which was stable during the research time.But the percentage rate of Hepatitis C increased from 8.45%in 2006 to 15.58%in 2014.There was significant difference for the hospitalization length of patients with hepatitis B virus from 2006 to 2014 and become shorter and shorter(P<0.001).For patients with HBV,the age group 31-60 was the predominated population,and the percentage rate was more than 60%each year.And there was no significant difference about overall difference for percentage rates in this age group(P=0.36).However,the percentage rate of age group 14-23 obviously decreased during the period(P=0.01).Conclusion:Liver diseases were important diseases in the department of infectious diseases in our hospital.Noninfectious liver diseases just like drug-induced liver injury and autoimmune liver disease should be given more care.HBV and HCV were the main reasons for the patients with viral hepatitis.Meanwhile,prevention and treatment of hospitalized patients with chronic hepatitis B or C virus was still a challenge in our hospital.Part Ⅱ:Research on the association between HBV or HCV infection and extra-hepatic malignanciesObjective:To explore the relationship between HBV or HCV infection and extra-hepatic malignancies and know about the trends in our area.Methods:Inpatients diagnosed with lymphoma,breast cancer,thyroid cancer,kidney cancer and pancreatic cancer as well as inpatients with no cancers were enrolled from the First Affiliated Hospital with Nanjing Medical University during Jan 2008 to Dec 2016.We did a case-control study by retrospective analysis.Patients with above mentioned five malignancies were regarded as research group and patients with no cancers diagnosed at the same year were regarded as control group.Both groups were completely matched by gender and age by the ratio of 1:1.Seropositivity of HBsAg stands for HBV infection and seropositivity of anti-HCV stands for HCV infection.The different prevalences of HBsAg,anti-HBs,anti-HBc and anti-HCV seropositivity were analyzed between research group and control group.Meanwhile,the data of research group were compared to the data from the 2006 National Hepatitis B and Hepatitis C sero-survey in China.Distributions of gender and age were analyzed between HBV-infected and HBV-uninfected patients with DLBCL.Results:Compared to control group,we found positive associations of HBV infection with NHL(OR = 2.10;95%CI,1.72-2.56),B-NHL(OR = 2.33;95%CI,1.90-2.86),DLBCL(OR = 2.07;95%CI,1.62-2.64),FL(OR = 3.38;95%CI,2.28-5.00),CLL/SLL(OR=1.91;95%CI,1.03-3.55),MZL(OR = 2.23;95%CI,1.37-3.62),MALT(OR=1.85;95%CI,1.00-3.44),SMZL(OR= 5.86;95%CI,2.28-15.28),and pancreatic cancer(OR =1.40;95%CI,1.07-1.84).However,non-significant associations were found between HBV infection and breast cancer(OR =1.01;95%CI,0.87-1.19)and thyroid cancer(OR =1.12;95%CI,0.91-1.36),as well as between HBV infection and kidney cancer(OR =0.86;95%CI,0.64-1.16).Compared to data from the 2006 National Hepatitis B sero-survey,for the men group,except non-significant associations found in MZL and MALT(P=0.548 and 0.603,respectively),other main subtypes of B-NHL were associated with HBV infection.For the women group,main subtypes of B-NHL were associated with HBV infection.However,there was no significant association between any of breast cancer,thyroid cancer,kidney cancer and pancreatic cancer and HBV infection.We found no differences of gender and age distributions between HBV-infected and HBV-uninfected patients with DLBCL(P=0.577 and 0.598,respectively).The prevalences of anti-HCV seropositivity of lymphoma,breast cancer,thyroid cancer,kidney cancer and pancreatic cancer were 0.75%,0.50%,0.33%,0.39%and 0.75%respectively.We found no significant relationship between above five extra-hepatic malignancies and HCV infection,so as to the subtypes of B-NHL.Compared to data from the 2006 National Hepatitis C sero-survey,only for the woman group,there was significant association between CLL/SLL and HCV infection(OR =14.69;95%CI,1.94-111.01).Conclusion:Our results indicated that NHL and some subtypes of NHL as well as pancreatic cancer were related to HBV infection.For distributions of gender and age,the differences were not obvious between HBV-infected and HBV-uninfected patients with DLBCL.There was significant association between only CLL/SLL and HCV infection in women.