CAJ | 학술논문

目的探讨江苏启东肝癌高发区乙型肝炎表面抗原(HBsAg)携带者血清病毒载量与肝癌发生的关系.方法利用1997年在启东建立的由477例HBsAg携带者和477名性别、年龄、居住地匹配的HBsAg阴性者组成的肝癌前瞻研究队列,分析1997年6月至2011年6月14年间肝癌发生与血清基线HBV DNA载量之间的关系.结果队列合计观察12 200人年.HBsAg阳性组肝癌发病率为1 498/10万人年,显著高于HBsAg阴性组的94/10万人年(P =0.000),相对危险度(RR)为15.96.其他肿瘤两组间差异无统计学意义(P=0.161).与HBsAg阴性组相比,肝癌发病在HBsAg +/HBeAg -和HBsAg +/HBeAg+组中的RR分别为11.38(95％ CI 4.87 ～26.62,P＜0.01)和29.08(95％ CI 12.37 ～68.37,P＜0.01),在HBsAg +/HBV DNA -和HBsAg +/HBV DNA+组中的RR分别为5.80(95％ CI 2.29～14.70,P＜0.01)和27.75(95％ CI 12.07～63.81,P＜0.01).HBsAg阳性组中,HBV DNA载量处于250～104 、104 ～、105～、106～和≥107拷贝/ml时发生肝癌的风险分别是载量＜250拷贝/ml组的2.84(95％ CI 1.44～5.61,P＜0.01)、5.75(95％ CI 2.77 ～ 11.95,P＜0.01)、9.05(95％ CI 4.71 ～ 17.41,P ＜0.01)、6.39(95％ CI 2.79 ～ 14.64,P＜0.01)和4.35倍(95％ CI 2.21～8.56,P＜0.01).结论 HBV DNA是启东肝癌重要的预警因子,血清HBV DNA载量在105 ～ 106拷贝/ml的HBsAg阳性者是发生肝癌的极高危人群.
목적 탐토강소계동간암고발구을형간염표면항원(HBsAg)휴대자혈청병독재량여간암발생적관계.방법 이용1997년재계동건립적유477례HBsAg휴대자화477명성별、년령、거주지필배적HBsAg음성자조성적간암전첨연구대렬,분석1997년6월지2011년6월14년간간암발생여혈청기선HBV DNA재량지간적관계.결과 대렬합계관찰12 200인년.HBsAg양성조간암발병솔위1 498/10만인년,현저고우HBsAg음성조적94/10만인년(P =0.000),상대위험도(RR)위15.96.기타종류량조간차이무통계학의의(P=0.161).여HBsAg음성조상비,간암발병재HBsAg +/HBeAg -화HBsAg +/HBeAg+조중적RR분별위11.38(95％ CI 4.87 ～26.62,P＜0.01)화29.08(95％ CI 12.37 ～68.37,P＜0.01),재HBsAg +/HBV DNA -화HBsAg +/HBV DNA+조중적RR분별위5.80(95％ CI 2.29～14.70,P＜0.01)화27.75(95％ CI 12.07～63.81,P＜0.01).HBsAg양성조중,HBV DNA재량처우250～104 、104 ～、105～、106～화≥107고패/ml시발생간암적풍험분별시재량＜250고패/ml조적2.84(95％ CI 1.44～5.61,P＜0.01)、5.75(95％ CI 2.77 ～ 11.95,P＜0.01)、9.05(95％ CI 4.71 ～ 17.41,P ＜0.01)、6.39(95％ CI 2.79 ～ 14.64,P＜0.01)화4.35배(95％ CI 2.21～8.56,P＜0.01).결론 HBV DNA시계동간암중요적예경인자,혈청HBV DNA재량재105 ～ 106고패/ml적HBsAg양성자시발생간암적겁고위인군.
Objective To explore the relationship between serum HBV DNA load and hepatocellular carcinogenesis in Qidong HBsAg carriers.Methods In 1997,477 HBsAg carriers and 477 age,gender and residence matched HBsAg negative controls were enrolled as a prospective cohort in Qidong city.The entry serum samples were detected for the levels of HBeAg and HBV DNA.The relationship between baseline HBV DNA load and hepatocellular carcinoma (HCC) during the follow-up period from June 1997 to June 2011 were analyzed.Results The total observed person-years (PY) were 12 200.Eightyseven patients developed HCC with an incidence of 1498/100 000 PY in the HBsAg positive group versus 6 with an incidence of 94/100 000 PY ( P =0.000) in the HBsAg negative group.The relative risk (RR) was 15.96.No significant difference existed between the incidences of other tumors in two groups ( P =0.161 ).Compared with the HBsAg negative group,the RR of HCC was 11.38(95％ CI 4.87 -26.62,P ＜0.01 ) in the HBsAg +/HBeAg - group and 29.08 ( 95％ CI 12.37 - 68.37,P ＜ 0.01 ) in the HBsAg + /HBeAg + group; 5.80(95％ CI 2.29 - 14.70,P ＜0.01 ) in the HBsAg +/HBV DNA - group and 27.75 (95％ CI 12.07 -63.81,P ＜0.01 )in the HBsAg +/HBV DNA + group.In HBsAg positive subjects,while the HBV DNA load was classified into 5 levels namely 250-104,104-,105-,106- and ≥107 copies/ml,the relative risks for HCC at each level were 2.84 ( 95％ CI 1.44 - 5.61,P ＜ 0.01 ),5.75 (95％ CI 2.77 -11.95,P＜0.01),9.05(95％ CI 4.71-17.41,P＜0.01),6.39(95％ CI 2.79-14.64,P＜0.01)and 4.35 (95％ CI 2.21 - 8.56,P ＜ 0.01 ) respectively versus the ＜ 250 copies/ml group.Conclusion HBV DNA is an important risk predictor of hepatocellular carcinoma.The HBsAg carriers with the serum loads of HBV DNA between 105 - 106 copies/ml are most likely to present with HCC.