Ribes Josepa, Clèries Ramon, Rubió Antoni, Hernández Josep Manel, Mazzara Roberto, Madoz Pedro, Casanovas Teresa, Casanova Aurora, Gallen Manel, Rodríguez Carmen, Moreno Victor, Bosch F Xavier
Epidemiology and Cancer Registration, Institut Català d'Oncologia, and Blod Bank, Hospital Universitari de Bellvitge, Hospitalet del Llobregat, Spain.
Int J Cancer. 2006 Aug 1;119(3):687-94. doi: 10.1002/ijc.21882.
The risk of developing liver cancer in hepatitis B virus (HBV) carriers differs across geographical areas, suggesting that exposure to other risk factors may contribute to HBV-linked cancer risk. Our study estimates the mortality due to liver disease and the role of other risk factors in a Spanish HBV cohort. 2,352 hepatitis B surface antigen (HBsAg)-positive and 15,504 HBsAg-negative subjects were identified among blood donors during 1972-1985 and were followed until December 2000 through the Mortality Registry. Clinical examination and an epidemiological questionnaire were performed on 1,000 HBsAg-positive survivors during 1994-1996. In subjects deceased from liver disease, medical records were revised and relatives were interviewed. A nested case-control analysis was conducted comparing both groups. In HBsAg-positive men, an excess mortality from liver cancer [standardized mortality ratio (SMR): 14.1; 7.7-23.6], cirrhosis (SMR: 10.5; 7.0-15.1), haematological neoplasms (SMR: 3.2; 1.2-6.9) and AIDS was detected (SMR: 5.5; 2.2-11.4). In women, an excess was found for cirrhosis (SMR: 7.2; 1.4-21.1). Progression factors to liver disease were alcohol intake [odds ratio (OR): 6.3; 3.1-12.8], diabetes (OR: 3.6; 1.3-9.6), HBV replication (OR: 50.0; 14.9-167.3) and hepatitis C virus (HCV) infection (OR: 27.4; 7.1-107.7). In conclusion, in Spain after 20 years of follow-up, chronic HBV exposure appears as a major risk factor for liver cancer among men and for cirrhosis in both sexes. The risk of death from liver disease among HBV carriers with the presence of HBV replication, HCV, alcohol consumption and diabetes was significantly increased and suggests synergism among these exposures and HBV. Mortality from haematological neoplasms was detected and could be associated to HIV coinfection. These results support screening and adequate follow-up among HBsAg-positive subjects at high risk to develop liver disease, particularly when these risk cofactors are present.
乙肝病毒（HBV）携带者患肝癌的风险在不同地理区域存在差异，这表明接触其他风险因素可能会增加与HBV相关的癌症风险。我们的研究评估了西班牙一个HBV队列中肝病导致的死亡率以及其他风险因素的作用。在1972年至1985年期间的献血者中，识别出2352名乙肝表面抗原（HBsAg）阳性和15504名HBsAg阴性受试者，并通过死亡率登记处对他们进行随访，直至2000年12月。在1994年至1996年期间，对1000名HBsAg阳性幸存者进行了临床检查和流行病学问卷调查。对于因肝病死亡的受试者，查阅了医疗记录并对其亲属进行了访谈。进行了一项巢式病例对照分析以比较两组情况。在HBsAg阳性男性中，发现肝癌（标准化死亡比[SMR]：14.1；7.7 - 23.6）、肝硬化（SMR：10.5；7.0 - 15.1）、血液系统肿瘤（SMR：3.2；1.2 - 6.9）和艾滋病（SMR：5.5；2.2 - 11.4）的死亡率过高。在女性中，发现肝硬化死亡率过高（SMR：7.2；1.4 - 21.1）。肝病进展的因素包括酒精摄入（比值比[OR]：6.3；3.1 - 12.8）、糖尿病（OR：3.6；1.3 - 9.6）、HBV复制（OR：50.0；14.9 - 167.3）和丙型肝炎病毒（HCV）感染（OR：27.4；7.1 - 107.7）。总之，在西班牙经过20年的随访，慢性HBV感染似乎是男性患肝癌以及男女患肝硬化的主要风险因素。存在HBV复制、HCV感染、饮酒和糖尿病的HBV携带者肝病死亡风险显著增加，这表明这些暴露因素与HBV之间存在协同作用。还检测到血液系统肿瘤导致的死亡，可能与HIV合并感染有关。这些结果支持对有患肝病高风险的HBsAg阳性受试者进行筛查和适当随访，特别是当存在这些风险协同因素时。
