Wang Na, Zheng Yingjie, Yu Xinsen, Lin Wenyao, Chen Yue, Jiang Qingwu
Department of Epidemiology, Fudan University, Shanghai, People's Republic of China.
Am J Epidemiol. 2009 Apr 15;169(8):990-5. doi: 10.1093/aje/kwn418. Epub 2009 Feb 18.
Sex and hepatitis B virus (HBV) infection are both important risk factors for primary liver cancer. However, their possible biologic interaction has not been well studied. The authors examined data from 89,789 subjects aged 25-69 years who participated in a 14-year cohort study (1992-2006) conducted in Haimen, China. An age-stratified Cox proportional hazards model was used for multivariate analysis. The authors assessed the combined effect of sex and HBV infection on liver cancer mortality by calculating 3 interaction measures: the relative risk due to interaction, the attributable proportion of interaction, and the synergy index. There was a greater risk difference between hepatitis B surface antigen carriers and noncarriers among men than among women. After adjustment for potential confounders, the relative risk due to interaction, the attributable proportion of interaction, and the synergy index were 33.27 (95% confidence interval (CI): 22.54, 43.99), 0.59 (95% CI: 0.55, 0.63), and 2.49 (95% CI: 2.13, 2.90), respectively, suggesting a significant synergistic effect of the interaction between sex and HBV infection on liver cancer mortality. HBV infection had a larger impact on liver cancer mortality in men than in women, which may explain at least part of the sex difference in liver cancer risk.
性别和乙型肝炎病毒（HBV）感染都是原发性肝癌的重要危险因素。然而，它们之间可能的生物学相互作用尚未得到充分研究。作者分析了来自中国海门的89789名年龄在25至69岁之间的受试者的数据，这些受试者参与了一项为期14年的队列研究（1992 - 2006年）。采用年龄分层的Cox比例风险模型进行多变量分析。作者通过计算3种相互作用指标评估了性别和HBV感染对肝癌死亡率的联合效应：相互作用导致的相对风险、相互作用的归因比例和协同指数。男性中乙肝表面抗原携带者与非携带者之间的风险差异大于女性。在对潜在混杂因素进行调整后，相互作用导致的相对风险、相互作用的归因比例和协同指数分别为33.27（95%置信区间（CI）：22.54，43.99）, 0.59（95%CI：0.55，0.63）和2.49（95%CI：2.13，2.90），表明性别与HBV感染之间的相互作用对肝癌死亡率有显著的协同效应。HBV感染对男性肝癌死亡率的影响大于女性，这可能至少部分解释了肝癌风险的性别差异。
