Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
Centro de Investigaciones Biomédicas, Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala, Guatemala, Guatemala.
BMJ Open Gastroenterol. 2020 Jul;7(1). doi: 10.1136/bmjgast-2020-000380.
In Guatemala, cirrhosis is among the 10 leading causes of death, and mortality rates have increased lately. The reasons for this heavy burden of disease are not clear as the prevalence of prominent risk factors, such as hepatitis B virus, hepatitis C virus and heavy alcohol consumption, appears to be low. Aflatoxin B (AFB) exposure, however, appears to be high, and thus could be associated with the high burden of cirrhosis. Whether AFB increases the risk of cirrhosis in the absence of viral infection, however, is not clear.
Cirrhosis cases (n=100) from two major referral hospitals in Guatemala City were compared with controls (n=200) from a cross-sectional study. Logistic regression was used to estimate the ORs and 95% CIs of cirrhosis and quintiles of AFB in crude and adjusted models. A sex-stratified analysis was also conducted.
The median AFB level was significantly higher among the cases (11.4 pg/mg) than controls (5.11 pg/mg). In logistic regression analyses, higher levels of AFB was associated with cirrhosis (quintile 5 vs quintile 1, OR: 11.55; 95% CI 4.05 to 32.89). No attenuation was observed with adjustment by sex, ethnicity, hepatitis B virus status, and heavy alcohol consumption. A significantly increasing trend in association was observed in both models (p trend <0.01). Additionally, the cirrhosis-AFB association was more prominent among men.
The current study found a significant positive association between AFB exposure and cirrhosis. Mitigation of AFB exposure and a better understanding of additional risk factors may be important to reduce the burden of cirrhosis in Guatemala.
在危地马拉，肝硬化是导致死亡的 10 大原因之一，其死亡率最近有所上升。造成这种严重疾病负担的原因尚不清楚，因为乙型肝炎病毒、丙型肝炎病毒和大量饮酒等主要危险因素的流行率似乎较低。然而，黄曲霉毒素 B（AFB）的暴露率似乎很高，因此可能与肝硬化的高负担有关。然而，在没有病毒感染的情况下，AFB 是否会增加肝硬化的风险尚不清楚。
将来自危地马拉城两家主要转诊医院的肝硬化病例（n=100）与横断面研究中的对照组（n=200）进行比较。使用逻辑回归来估计肝硬化和 AFB 五分位数的 OR 和 95%CI 在粗模型和调整模型中的比值比。还进行了性别分层分析。
病例组的中位 AFB 水平（11.4pg/mg）明显高于对照组（5.11pg/mg）。在逻辑回归分析中，较高的 AFB 水平与肝硬化相关（五分位 5 与五分位 1，OR：11.55；95%CI 4.05 至 32.89）。通过调整性别、种族、乙型肝炎病毒状态和大量饮酒，未观察到衰减。在两种模型中均观察到与关联呈显著递增趋势（p 趋势<0.01）。此外，肝硬化与 AFB 的关联在男性中更为明显。
本研究发现，AFB 暴露与肝硬化之间存在显著的正相关关系。减轻 AFB 暴露和更好地了解其他危险因素可能对减轻危地马拉的肝硬化负担很重要。
