英格兰和威尔士乙肝表面抗原阳性献血者的死亡率。

Mortality of hepatitis B surface antigen-positive blood donors in England and Wales.

作者信息

Crook Paul D, Jones Michael E, Hall Andrew J

机构信息

London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

出版信息

Int J Epidemiol. 2003 Feb;32(1):118-24. doi: 10.1093/ije/dyg039.

DOI:10.1093/ije/dyg039

PMID:12690022

Abstract

BACKGROUND

Large population-based cohort studies in areas of high hepatitis B virus (HBV) prevalence have provided the evidence establishing hepatitis B surface antigen (HBsAg) carriage as a risk factor for hepatocellular carcinoma (HCC) and liver disease. Fewer studies have examined this in Western countries, where both HBV infection and carriage are less common and transmission patterns differ. This is the only prospective population-based study to examine this relationship in Europe.

METHODS

In all, 2681 male and 977 female blood donors in England and Wales, found to be HBsAg positive during routine blood-donation screening, were followed up from recruitment in 1970-1982 to December 1999 and their cause-specific mortality was analysed. This was compared with that of the general population of England and Wales.

RESULTS

During a mean of 22 years of follow-up, 17.4% of the 420 deaths were due to HCC or liver disease. There were 20 deaths from HCC in male HBsAg carriers, representing a significantly high standardized mortality ratio (SMR) compared to the male population of England and Wales of 26 (SMR = 26.26; 95% CI: 16.04- 40.54). The HCC incidence rate in males was 33.5 per 100 000 person years and 4.4 per 100 000 person years in females. Men had 8.5 (SMR = 8.50; 95% CI: 6.25- 11.31) and women had 3.9 times the risk of death from liver disease (SMR = 3.89; 95% CI: 1.26-9.09). The risk of circulatory disease deaths was reduced in both males and females. There was a significant increased risk of non-Hodgkins lymphoma that was not apparent in the first decade of follow-up. The increased risk of HCC and liver disease in men fell with follow-up.

CONCLUSION

Hepatitis B surface antigen carriage is a significant risk factor in England and Wales for both liver disease and HCC mortality. However, this risk has declined with duration of follow-up. This could be due to natural reversion to HBsAg negativity or as a result of treatment and avoidance of other risk factors. The increased risk of non-Hodgkins lymphoma seen in longer follow-up is likely to be related to HIV infection acquired subsequent to recruitment.

摘要

背景

在乙型肝炎病毒（HBV）高流行地区开展的大规模人群队列研究已提供证据，证实乙肝表面抗原（HBsAg）携带状态是肝细胞癌（HCC）和肝病的危险因素。在西方国家，HBV感染和携带情况均较不常见且传播模式不同，针对这一情况进行研究的较少。这是欧洲唯一一项基于人群的前瞻性研究，旨在探究这种关系。

方法

在英格兰和威尔士，共有2681名男性和977名女性献血者在常规献血筛查中被发现HBsAg呈阳性，他们于1970年至1982年招募后接受随访，直至1999年12月，并对其特定病因死亡率进行分析。将此结果与英格兰和威尔士的普通人群进行比较。

结果

在平均22年的随访期间，420例死亡中有17.4%是由HCC或肝病所致。男性HBsAg携带者中有20例死于HCC，与英格兰和威尔士男性人群相比，标准化死亡率（SMR）显著较高，为26（SMR = 26.26；95%置信区间：16.04 - 40.54）。男性HCC发病率为每10万人年33.5例，女性为每10万人年4.4例。男性因肝病死亡的风险是普通人群的8.5倍（SMR = 8.50；95%置信区间：6.25 - 11.31），女性为3.9倍（SMR = 3.89；95%置信区间：1.26 - 9.09）。男性和女性因循环系统疾病死亡的风险均降低。非霍奇金淋巴瘤的风险显著增加，在随访的头十年中并不明显。男性HCC和肝病的风险随着随访时间的延长而降低。