乙型肝炎病毒感染与肝癌发生的31年随访研究

目的 研究乙型肝炎病毒(HBV)与肝癌发生的关系,评价HBsAg长期携带者发生肝癌的结局.方法 利用1976年建立的启东某社区15岁以上自然人群队列[血清筛检确定HBsAg、抗-HBs及丙氨酸转氨酶(ALT),并进行前瞻随访],该数据库与人群癌症登记资料、居民病伤死因资料链接核实,分析1977年1月至2007年12月12351名人群中肝癌等肿瘤的发生情况.结果 队列观察总人年数为355 305.0.HBsAg携带者中发生肝癌173例,发生率为361.55/10万;HBsAg非携带者发生肝癌95例,发生率为30.90/10万,两组比较RR=11.70(95%CI:9.06～15.19);其中男性和女性HBsAg携带者的RR值分别为12.30和10.46.两性各年龄组HBsAg携带者的肝癌发生率均高于非携带者.若以女性非携带者肝癌的发生率为1,则男性非携带者、女性携带者、男性携带者的RR值分别为3.07、10.46和37.76;该四组人群在31年中肝癌发生的累积率分别为0.86%、2.73%、10.22%和34.19%.非条件logistic回归模型分析显示性别(男性)、年龄、HBsAg、ALT为肝癌发生的显著影响因素,抗-HBs为保护因素.HBsAg携带与其他部位癌的发生未见有联系.结论 证实启东自然人群中HBsAg携带与肝癌发生的因果联系;针对HBV感染而采取干预措施是现场肝癌防治的重点.

A thirty-one year prospective follow-up program on the HBsAg carrier state and primary liver cancer in Qidong, China

Objective To study the relationship between hepatitis B virus (HBV) and primary liver cancer (PLC), and to assess the outcome of PLC in the carriers of HBsAg. Methods General population over age of 15 from a community in Qidong was screened for HBsAg, anti-HBs,and alanine transaminase (ALT) in 1976, and followed-up thenceforth. From January 1, 1977 through December 31, 2007, 12 351 people were enrolled in the cohort, and their occurrence, outcome of PLC and other cancers, together with all the withdrawals due to death were linked to and checked with database from Qidong Cancer Registry and Qidong Vital Registry programs. Results The total observed person-years (PYs) were 355 305.0. One hundred and seventy-three PLC cases were identified among the HBsAg carriers, with an incidence of 361.55 per 100 000 PYs, while PLC cases were only 95 for the non-carriers, with an incidence of 30.90 per 100 000 PYs. The overall relative risk (RR)was 11.70(95%CI: 9.06-15.19) ,with RR 12.30 for men and 10.46 for women. HBsAg carriers had high incidence at each age group,compared with the non-carriers for both men and women. Data from cross-over analysis showed that the incidence rates of PLC for the sub-cohorts of female non-carriers,male non-carriers, female carriers, and male carriers were 1.00,3.07, 10.46, and 37.76, respectively.The cumulative rates of PLC in the 4 groups were 0.86%, 2.73%, 10.22%, and 34.19%, respectively.Results from aon-conditional logistic regression model showed that the gender (male), age, HBsAg ( + ), and ALT( + ) were risk factors for the development of PLC while anti-HBs( + ) demonstrated a protective effect. No relationship was found among carriers and non-carriers for cancer sites such as lung, stomach, esophagus, intestine, pancreas, breast, cervix, bladder, and lymphoma, brain tumor, or leukemia. Conclusion Causation and its strength, together with specificity and persistency of the association were confirmed from this HBsAg-related cohort study in the general population in Qidong.Intervention measures on HBV should be highlighted for the control of PLC among the HBV infected individuals.