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从世界卫生组织全球消除肝炎的角度看病毒引起的肝细胞癌的流行病学预测。

Epidemiological projections of viral-induced hepatocellular carcinoma in the perspective of WHO global hepatitis elimination.

机构信息

Université Paris-Sud, Université Paris-Saclay, Kremlin-Bicêtre, France.

AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France.

出版信息

Liver Int. 2021 May;41(5):915-927. doi: 10.1111/liv.14843. Epub 2021 Mar 18.

Abstract

Hepatitis B is an eminent risk factor for hepatocellular carcinoma (HCC) in Southeast Asia and sub-Saharan Africa, whereas hepatitis C is a key risk factor for HCC in Western Europe and North America. Increased awareness of the global burden of viral hepatitis resulted, in May 2016, in the adoption of the first global health sector strategy on viral hepatitis by the World Health Assembly, which calls for the elimination of viral hepatitis as a public health threat by 2030. Although the incidence of liver cancer resulting from viral infections has increased since the 1990s, the implementation of public health interventions, such as hepatitis B vaccination and antiviral therapies might have reduced the global burdens of HCC. Hepatitis B immunization in infancy has been associated with a reduction in the risk of infant fulminant hepatitis, chronic liver disease, and HCC in Taiwan. Achieving viral hepatitis elimination by 2030 can be accelerated by improving the access to HCC screening programs. HCC surveillance programs in developed countries must be refined to increase an access to personalized surveillance program, whereas the limited access to surveillance and treatment of HCC in developing countries remains a significant public health issue.

摘要

乙型肝炎是东南亚和撒哈拉以南非洲地区肝细胞癌(HCC)的一个重要危险因素,而丙型肝炎是西欧和北美地区 HCC 的关键危险因素。对全球病毒性肝炎负担的认识不断提高,促使世界卫生大会于 2016 年 5 月通过了第一项全球病毒性肝炎卫生部门战略,该战略呼吁到 2030 年消除病毒性肝炎这一公共卫生威胁。虽然自 20 世纪 90 年代以来,由病毒感染引起的肝癌发病率有所上升,但由于实施了乙型肝炎疫苗接种和抗病毒治疗等公共卫生干预措施,全球 HCC 的负担可能已经减轻。在台湾,婴儿时期接种乙型肝炎疫苗与降低婴儿暴发性肝炎、慢性肝病和 HCC 的风险有关。通过改善 HCC 筛查计划的可及性,到 2030 年实现消除病毒性肝炎的目标可以加速实现。必须改进发达国家的 HCC 监测计划,以增加获得个性化监测计划的机会,而发展中国家对 HCC 的监测和治疗的有限机会仍然是一个重大的公共卫生问题。

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