HBsAg携带者补硒后影响肝癌发生的实验流行病学研究

目的：评价补硒对HBsAg携带者肝癌发生的效果。方法：采用实验流行病学研究设计，以1996—1999年在启东肝癌高发区对HBsAg携带者补硒预防肝癌干预试验队列为实验对象，停药后定群随访到2004年，收集死亡资料。结果：停药后5年（2000—2004年）干预组肝癌（4．384％）和慢性肝炎（简称慢肝）或肝硬化（0．939％）的死亡率显著低于对照组（肝癌7．533％，U=2．827，P=0．005；慢肝或肝硬化2．552oA，U=2．636，P=0．009），干预组肝癌死亡相对危险度是对照组0．582倍（RR=0．582，95％CI：0．389～0．871），慢肝或肝硬化死亡相对危险度是对照组0．368倍（RR=0．368，95％，CI：0．168～0．808），硒与慢肝或肝硬化死亡关联强度较强；硒对肝癌、慢肝或肝硬化保护率分别为41.804％和63．182％。结论：HBsAg携带者持续补硒能有效降低肝癌和其他肝病的发生率，值得继续观察研究。

The effect of selenium intake on the risk of liver cancer of HBsAg carriers: a cohort study

Objective:To evaluate the effect of the selenium intake on the risk of liver cancer in HBsAg carriers.Methods:The experimental epidemiological design was used.In the intervention trial HBsAg carriers were recruited and radomly given selenium to prevent liver cancer in Qidong area,an area with high incidence of liver cancer,from 1996 to 1999,and were followed up till 2004.The data based on death were collected.Results:Five years(from 2000 to 2004) after termination of the intervention with selenium,cumulative mortality rate due to liver cancer(4.384%)and chronic hepatitis or hepatocirrhosis(0.939%)were significantly lower in the intervention group than the placebo group(mortality rate due to liver cancer: 7.533%,U=2.827,P=0.005;mortality rate due to chronic hepatitis or hepatocirrhosis : 2.552%,U=2.636,P=0.009.The relative risk of liver cancer-induced death in the intervention group was 0.582 fold of the control group(RR=0.582,95% CI : 0.389-0.871)and the relative risk of chronic hepatitis or hepatocirrhosis-induced death was 0.368 fold of the control group(RR=0.368,95% CI:(0.168)-0.808).There was a relatively strong relationship between selenium intake and chronic hepatitis or hepatocirrhosis-induced death.The protective rates of selenium intake against liver cancer and chronic hepatitis or hepatocirrhosis were 41.804% and(63.182)%,respectively.Conclusion:The selenium intake may effectively decrease the incidence of liver cancer and other liver diseases among HBsAg carriers,and the efficacy lasted more than five years after the termination of intervention.