AIM:To assess the role of the major risk factors for hepatocellular carcinoma(HCC) development in the western part of North Africa.METHODS:A multicenter case control study was conducted in Tunisia,Morocco and Algeria ...AIM:To assess the role of the major risk factors for hepatocellular carcinoma(HCC) development in the western part of North Africa.METHODS:A multicenter case control study was conducted in Tunisia,Morocco and Algeria in collaboration with Pasteur Institutes in these countries.A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included.Prevalences of HBsAg,anti-hepatitis C virus(HCV)and diabetes were assessed.HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients.RESULTS:The mean age of patients was 62±10 years old for a 1.5 M:F sex ratio.Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg.Diabetes was detected in 18% of cases.Odd ratio(OR)and 95% confidence intervals(CI) were 32.0(15.8-65.0),7.2(3.2-16.1) and 8.0(3.1 -20.0)for anti-HCV,HBsAg and diabetes respectively.Multivariate analysis indicated that the three studied factors were independent.1b HCV genotype and D HBV genotype were predominant in HCC patients.HCV was the only risk factor significantly associated with an excess of cirrhosis(90% vs 68% for all other risk factors collectively,P=0.00168).Excessive alcohol consumption was reliably established for 19(17.6%) cases among the 108 HCC patients for whom data is available.CONCLUSION:HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa.An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.Salah Berkane,Department of Gastroenterology BologhineUniversity Hospital,Bologhine 16090,Algiers。展开更多
syndrome （BCS） and identify the aetiologies of thisdisease in Algeria.METHODS： Patients with BCS, hospitalised in our unitfrom January 2004 until June 2010 were included and theaetiological factors were assessed. P...syndrome （BCS） and identify the aetiologies of thisdisease in Algeria.METHODS： Patients with BCS, hospitalised in our unitfrom January 2004 until June 2010 were included and theaetiological factors were assessed. Patients presentinga BCS in the setting of advanced-stage cirrhosis or aliver transplantation were excluded from the study. Thediagnosis was established when an obstruction of hepaticvenous outflow （thrombosis, stenosis or compression）was demonstrated. We diagnosed myeloproliferativedisease （MPD） by bone marrow biopsy and V617FJAK2 mutation. Anti-phospholipid syndrome （APLS） wasdetected by the presence of anticardiolipin antibodies,anti-β2 glycoprotein antibodies and Lupus anticoagulant.We also detected paroxysmal nocturnal haemoglobinuria（PNH） by flow cytometry. Celiac disease and Beh？etdisease were systematically investigated in our patients.Hereditary anticoagulant protein deficiencies were alsoassessed. We tested our patients for the G20210Amutation at Beaujon Hospital. Imaging procedures wereperformed to determine a local cause of BCS, such as ahydatid cyst or a liver tumour.RESULTS： One hundred and fifteen patients wereincluded. Mean follow up： 32.12 mo. Mean age： 34.41years, M/F = 0.64. Chronic presentation was frequent：63.5%. The revealing symptoms for the BCS wereascites （74.8%） and abdominal pain （42.6%）. Themost common site of thrombosis was the hepatic veins（72.2%）. Involvement of the inferior vena cava alonewas observed in 3 patients. According to the radiologicalinvestigations, BCS was primary in 94.7% of the cases（n = 109） and secondary in 5.2% （n = 6）. An aetiologywas identified in 77.4% of the patients （n = 89）; itwas multifactorial in 27% （n = 31）. The predominantaetiology of BCS in our patients was a myeloproliferativedisease, observed in 34.6% of cases. APLS was foundin 21.7% and celiac disease in 11.4%. Other acquiredconditions were： PNH （n = 4）, systemic disease （n = 6）and inflammatory bowel disease （n = 5）. Anticoagulantprotein deficiency was diagnosed in 28% of the patients（n = 18）, dominated by protein C deficiency （n = 13）.Secondary BCS was caused by a compressing hydaticcyst （n = 5） and hepatocellular carcinoma （n = 1）.CONCLUSION： The main aetiologic factor of BCS inAlgeria is MPD. The frequency of celiac disease justifiesits consideration when BCS is diagnosed in our region.展开更多
基金Supported by the"Direction des Programmes Transversaux de Recherches of the Institut Pasteur of Paris(PTR 130)"the "Tunisian Secretariat for Scientific Research and Technology SERST for Tunisian part of the study(LR:Hépatites et maladies viralesépidémiques)"
文摘AIM:To assess the role of the major risk factors for hepatocellular carcinoma(HCC) development in the western part of North Africa.METHODS:A multicenter case control study was conducted in Tunisia,Morocco and Algeria in collaboration with Pasteur Institutes in these countries.A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included.Prevalences of HBsAg,anti-hepatitis C virus(HCV)and diabetes were assessed.HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients.RESULTS:The mean age of patients was 62±10 years old for a 1.5 M:F sex ratio.Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg.Diabetes was detected in 18% of cases.Odd ratio(OR)and 95% confidence intervals(CI) were 32.0(15.8-65.0),7.2(3.2-16.1) and 8.0(3.1 -20.0)for anti-HCV,HBsAg and diabetes respectively.Multivariate analysis indicated that the three studied factors were independent.1b HCV genotype and D HBV genotype were predominant in HCC patients.HCV was the only risk factor significantly associated with an excess of cirrhosis(90% vs 68% for all other risk factors collectively,P=0.00168).Excessive alcohol consumption was reliably established for 19(17.6%) cases among the 108 HCC patients for whom data is available.CONCLUSION:HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa.An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.Salah Berkane,Department of Gastroenterology BologhineUniversity Hospital,Bologhine 16090,Algiers。
文摘syndrome （BCS） and identify the aetiologies of thisdisease in Algeria.METHODS： Patients with BCS, hospitalised in our unitfrom January 2004 until June 2010 were included and theaetiological factors were assessed. Patients presentinga BCS in the setting of advanced-stage cirrhosis or aliver transplantation were excluded from the study. Thediagnosis was established when an obstruction of hepaticvenous outflow （thrombosis, stenosis or compression）was demonstrated. We diagnosed myeloproliferativedisease （MPD） by bone marrow biopsy and V617FJAK2 mutation. Anti-phospholipid syndrome （APLS） wasdetected by the presence of anticardiolipin antibodies,anti-β2 glycoprotein antibodies and Lupus anticoagulant.We also detected paroxysmal nocturnal haemoglobinuria（PNH） by flow cytometry. Celiac disease and Beh？etdisease were systematically investigated in our patients.Hereditary anticoagulant protein deficiencies were alsoassessed. We tested our patients for the G20210Amutation at Beaujon Hospital. Imaging procedures wereperformed to determine a local cause of BCS, such as ahydatid cyst or a liver tumour.RESULTS： One hundred and fifteen patients wereincluded. Mean follow up： 32.12 mo. Mean age： 34.41years, M/F = 0.64. Chronic presentation was frequent：63.5%. The revealing symptoms for the BCS wereascites （74.8%） and abdominal pain （42.6%）. Themost common site of thrombosis was the hepatic veins（72.2%）. Involvement of the inferior vena cava alonewas observed in 3 patients. According to the radiologicalinvestigations, BCS was primary in 94.7% of the cases（n = 109） and secondary in 5.2% （n = 6）. An aetiologywas identified in 77.4% of the patients （n = 89）; itwas multifactorial in 27% （n = 31）. The predominantaetiology of BCS in our patients was a myeloproliferativedisease, observed in 34.6% of cases. APLS was foundin 21.7% and celiac disease in 11.4%. Other acquiredconditions were： PNH （n = 4）, systemic disease （n = 6）and inflammatory bowel disease （n = 5）. Anticoagulantprotein deficiency was diagnosed in 28% of the patients（n = 18）, dominated by protein C deficiency （n = 13）.Secondary BCS was caused by a compressing hydaticcyst （n = 5） and hepatocellular carcinoma （n = 1）.CONCLUSION： The main aetiologic factor of BCS inAlgeria is MPD. The frequency of celiac disease justifiesits consideration when BCS is diagnosed in our region.
