乙肝病毒感染与肝癌发生的追踪随访

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,乙肝病毒感染与肝癌发生的追踪随访,乙肝病毒感染与肝癌发生的追踪随访,第1页,材 料 和 方 法,1.,对象,启东某小区,1976,年平均人口数为,32 053,人，,1976,年,9,月筛查该小区,15,岁以上自然人群,14 694,人（,45.84%,）；其中男性,6 272,人，女性,8 422,人。随访截至,年,12,月，失访率为,15.95%,，实际纳入本文分析为,12 351,人，占,84.05%,。,2.,血清学检测,普查人群分别用,R-PHA,法及,PHA,法检测血清,HBsAg,（阳性者作中和试验确诊）、抗,-HBs,；,HBsAg,检测结果用,2,几何级数,(2,x,),表示，,HBsAg,滴度,1:2,3,(,即,1:8),判为阳性。,乙肝病毒感染与肝癌发生的追踪随访,第2页,材 料 和 方 法,3.,病例确定,全部肝癌及其它肿瘤发生病例均与启东癌症登记处全人群癌症发病登记资料作查对。剔除,1976,年普查当年病例，计算,1977,年,1,月,1,日至,年,12,月,31,日之间发生癌症病例。,4.,人年计算,随访人年,(,PY,):,随访队列起始日历日期为,1977,年,1,月,1,日,(,A,b,),；截止日期,(,A,d,),计算：对于癌症患者，为癌症诊疗日期；非癌死亡者,(,出列者,),以死亡日期为随访截止日期；其它随访对象截止日期为,年,12,月,31,日。,随访人年,PY,=(,A,d,A,b,)/365.25,。,乙肝病毒感染与肝癌发生的追踪随访,第3页,前瞻人群,HBsAg,阳性率及截缩标化率,(,1976),年纪,检测例数,HBsAg,阳性,截缩人口中,预期发病数,*,例数,%,15-,1782,381,21.38,1.93,20-,2551,461,18.07,1.33,25-,1800,343,19.06,1.39,30-,1208,220,18.21,1.23,35-,1264,218,17.25,1.03,40-,1337,217,16.23,0.84,45-,1229,175,14.24,0.64,50-,973,171,17.57,0.67,55-,911,131,14.38,0.47,60-,1639,243,14.83,0.91,累计,14694,2560,17.42,10.44,男,6272,1195,19.05,-,女,8422,1365,16.21,-,*,据,1964,年全国家标准准人口组成，,15,岁以上截缩人口为,59.31%,，截缩标化率,=10.44/59.31=17.60%,乙肝病毒感染与肝癌发生的追踪随访,第4页,HBsAg,研究队列性别及年纪别随访人年,(1977-),年纪,HBsAg,携带者,HBsAg,非携带者,携带者与非携带者,男,女,累计,男,女,累计,男,女,累计,15-,338.0,562.0,900.0,1557.0,2782.0,4339.0,1895.0,3344.0,5239.0,20-,920.0,1363.0,2283.0,4375.9,7259.6,11635.5,5295.9,8622.6,13918.5,25-,1458.2,2222.4,3680.6,7044.2,11980.3,19024.5,8502.4,14202.7,22705.1,30-,1817.3,2982.2,4799.5,8986.8,15460.6,24447.4,10804.1,18442.8,29246.9,35-,2118.4,3472.4,5590.8,10488.4,18306.2,28794.6,12606.8,21778.6,34385.4,40-,2365.0,3943.6,6308.6,12206.3,21387.0,33593.3,14571.3,25330.7,39902.0,45-,2251.3,3897.3,6148.6,13019.1,22661.8,35680.9,15270.4,26559.1,41829.5,50-,1785.6,3232.2,5017.8,11742.4,20650.6,32393.0,13528.0,23882.7,37410.7,55-,1398.3,2580.2,3978.5,10273.3,17816.0,28089.3,11671.6,20396.2,32067.8,60-,1137.2,1896.0,3033.2,9109.9,15363.5,24473.4,10247.1,17259.5,27506.6,65-,857.6,1474.5,2332.1,8080.0,13342.3,21422.3,8937.6,14816.8,23754.4,70+,1389.5,2387.8,3777.3,16535.7,27026.1,43561.8,17925.2,29413.9,47339.1,累计,17836.4,30013.6,47850.0,113419.0,194036.0,307455.0,131255.4,224049.6,355305.0,乙肝病毒感染与肝癌发生的追踪随访,第5页,结 果,Cause-effect relationship,Strength,Specificity,Persistency,因果关系,强度,特异性,一致性,乙肝病毒感染与肝癌发生的追踪随访,第6页,Incidences and Relative Risk for Liver Cancer,by HBsAg Carrier State,1977,Qidong,China,Sex,HBsAg(+),HBsAg(-),RR,95%CI,P-Yrs,No.of,Cases,Incidence,Per 10,5,P-Yrs,No.of,Cases,Incidence,Per 10,5,M,17836.4,118,661.57,113419.0,61,53.78,12.30,8.96-17.04,F,30013.6,55,183.25,194036.0,34,17.52,10.46,6.70-16.54,RR,3.61,3.07,95%CI,2.60-5.07,1.99-4.82,乙肝病毒感染与肝癌发生的追踪随访,第7页,HBsAg,携带者与非携带者中病例发生分布,乙肝病毒感染与肝癌发生的追踪随访,第8页,Age Specific Rate of Liver Cancer in HBsAg Carriers and Non-Carriers,37.76 10.46 3.07 1.00,乙肝病毒感染与肝癌发生的追踪随访,第9页,HBsAg Carrier State and Liver Cancer by Period,Qidong,China,Period,Sex,HBsAg(+),HBsAg(-),RR,95%,CI,P-Yrs,No.,Rate,P-Yrs,No.,Rate,1977-1986,M,11030,41,371.71,47654,16,33.58,11.07,6.08-21.13,F,12797,18,140.66,66598,8,12.01,11.71,4.84-31.12,T,23827,59,247.62,114252,24,21.01,11.79,7.22-19.81,1977-1998,M,13402.2,83,619.30,75428.8,39,51.70,11.98,8.09-18.00,F,21653.5,42,193.96,131982.7,15,11.37,17.06,9.27-33.13,T,35055.7,125,356.58,207411.5,54,26.04,13.69,9.88-19.21,1977-,M,17836.4,118,661.57,113419.0,61,53.78,12.30,8.96-17.04,F,30013.6,55,183.25,194036.0,34,17.52,10.46,6.70-16.54,T,47850.0,173,361.55,307455.0,95,30.90,11.70,9.06-15.19,乙肝病毒感染与肝癌发生的追踪随访,第10页,HBsAg,携带状态与恶性肿瘤发病率,(1/10,万,),及相对危险度,肿瘤名称,男,女,sAg(+),sAg(-),RR,95%,CI,sAg(+),sAg(-),RR,95%,CI,肝癌,661.57,53.78,12.3,8.96-17.04,183.25,17.52,10.46,6.70-16.54,肺癌,78.49,82,0.96,0.50-1.69,19.99,28.35,0.7,0.25-1.64,胃癌,50.46,76.71,0.66,0.29-1.31,23.32,35.05,0.67,0.26-1.45,食管癌,33.64,26.45,1.27,0.43-3.11,10,12.37,0.81,0.16-2.66,肠癌,22.43,19.4,1.16,0.29-3.40,16.66,20.1,0.83,0.25-2.10,胰腺癌,16.82,14.99,1.12,0.21-3.88,10,10.82,0.92,0.18-3.09,乳腺癌,3.33,12.88,0.26,0.01-1.58,宫颈癌,16.66,6.7,2.49,0.69-7.43,淋巴瘤,11.21,8.82,1.27,0.14-5.97,0,2.06,0,0.00-9.79,脑肿瘤,5.61,7.05,0.79,0.02-5.93,0,3.09,0,0.00-5.49,膀胱癌,5.61,7.94,0.71,0.02-5.10,0,2.06,0,0.00-9.79,白血病,0,4.41,0,0.00-6.94,6.66,3.09,2.15,0.21-12.05,其它,33.64,14.99,2.24,0.72-5.97,13.33,15.46,0.86,0.22-0.45,全部癌症,919.47,317.41,2.89,2.39-3.49,303.2,169.56,1.79,1.40-2.26,全部癌症,257.9,263.62,0.98,0.70-1.34,119.95,152.03,0.79,0.54-1.12,(,肝癌除外,),Chen JG,et al.In publication,乙肝病毒感染与肝癌发生的追踪随访,第11页,危险原因与肝癌关系非条件,Logistic,回归模型结果,乙肝病毒感染与肝癌发生的追踪随访,第12页,讨 论,全球汇报,HBV,与肝癌关系研究人群起源大致有三大类：一是以人群为基础，二是以阳性者特定人群为对象，三是以患者为对象。鲜见超出,30,年以人群为基础前瞻性汇报。本队列开始于,1976,年，是我国最早研究自然人群中,HBsAg,携带与肝癌关系前瞻队列之一，因而能够为,HBV,感染后长久结局研究提供更可靠流行病学证据。,31,年随访研究显示，,HBsAg(+),者肝癌发生率为,361.55/10,万，,HBsAg(-),者发生率为,30.90/10,万，阳性者发生肝癌相对危险度,(RR),为,11.70,（其中男性及女性,RR,分别为,12.30,及,10.46,）。该结果与本队列在随访,10,年、,20,年时结果基础一致。,乙肝病毒感染与肝癌发生的追踪随访,第13页,讨 论,本研究表明，在,HBV,感染后，肝癌发生过程少则几年，多则可达,30,年甚至更长。其影响原因可能与年纪和患者感染程度或慢性化过程相关。,非条件,Logistic,回归模型单原因分析，显示性别,(,男,),、,HBsAg(+),、,ALT(+),为肝癌发生显著影响原因，而抗,-HBs(+),为保护原因。在逐步回归分析中，抗,-HBs,原因被剔除，入列年纪、性别,(,男,),、,HBsAg(+),、,ALT(+)