慢性乙型肝炎病毒感染和慢性肾病的风险：一项基于人群的50

StephenW

BMC Med. 2018 Jun 18;16(1):93. doi: 10.1186/s12916-018-1084-9.
Chronic hepatitis B virus infection and risk of chronic kidney disease: a population-based prospective cohort study of 0.5 million Chinese adults.
Si J1, Yu C1, Guo Y2, Bian Z2, Qin C1, Yang L3, Chen Y3, Yin L4, Li H5, Lan J6, Chen J7, Chen Z3, Lv J8,9, Li L1,2; China Kadoorie Biobank Collaborative Group.
Author information

1
    Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.
2
    Chinese Academy of Medical Sciences, Beijing, China.
3
    Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
4
    Hunan Center for Disease Control & Prevention, Changsha, Hunan, China.
5
    Liuzhou Traditional Chinese Medical Hospital, Liuzhou, Guangxi, China.
6
    Liuzhou Center for Disease Control & Prevention, Liuzhou, Guangxi, China.
7
    China National Center for Food Safety Risk Assessment, Beijing, China.
8
    Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China. [email protected].
9
    Peking University Institute of Environmental Medicine, Beijing, China. [email protected].

Abstract
BACKGROUND:

Existing evidence remains inconclusive as to the association between chronic hepatitis B virus (HBV) infection and the risk of chronic kidney disease (CKD). We prospectively examined the association between chronic HBV infection and CKD risk, and the joint associations of HBV infection with established risk factors of several lifestyle factors and prevalent diseases on CKD risk.
METHODS:

Participants from the China Kadoorie Biobank were enrolled during 2004-2008 and followed up until 31 December 2015. After excluding participants with previously diagnosed CKD, cancer, heart disease, and stroke at baseline, the present study included 469,459 participants. Hepatitis B surface antigen (HBsAg) was qualitatively tested at baseline. Incident CKD cases were identified mainly through the health insurance system and disease and death registries.
RESULTS:

During a median follow-up of 9.1 years (4.2 million person-years), we documented 4555 incident cases of CKD. Cox regression yielded multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with HBsAg-negative participants, the multivariable-adjusted HR (95% CI) for CKD was 1.37 (1.18, 1.60) for HBsAg-positive participants. The association was stronger in men (HR = 1.77; 95% CI: 1.43, 2.20) than in women (HR = 1.10; 95% CI: 0.88, 1.36). HBsAg-positive participants, with or without hepatitis or cirrhosis, whether or not under treatment, all showed increased risk of developing CKD. We observed positive additive interactions of HBsAg positivity with smoking, physical inactivity, or diabetes on CKD risk. Compared with HBsAg-negative participants who were nonsmokers, more physically active, or did not have diabetes at baseline, the greatest CKD risk for HBsAg-positive participants was for those who were smokers (HR = 1.85; 95% CI: 1.44, 2.38), physically inactive (HR = 1.91; 95% CI: 1.52, 2.40), or diabetic (HR = 6.11; 95% CI: 4.47, 8.36).
CONCLUSIONS:

In countries with a high endemicity of HBV infection, kidney damage associated with chronic HBV infection should be a non-negligible concern. Our findings also highlight the importance of health advice on quitting smoking, increasing physical activity, improving glucose control, and early screening for CKD in people with chronic HBV infection.
KEYWORDS:

Chronic hepatitis B virus infection; Chronic kidney disease; Prospective cohort study

PMID:
    29909773
DOI:
    10.1186/s12916-018-1084-9

StephenW

BMC Med。 2018年6月18日; 16（1）：93。 doi：10.1186 / s12916-018-1084-9。
慢性乙型肝炎病毒感染和慢性肾病的风险：一项基于人群的50万中国成人前瞻性队列研究。
Si J1，Yu C1，Guo Y2，Bian Z2，Qin C1，Yang L3，Chen Y3，Yin L4，Li H5，Lan J6，Chen J7，Chen Z3，Lv J8,9，Li L1,2;中国嘉道理生物银行协作组。
作者信息

1
    北京市学院路38号北京大学医学部公共卫生学院流行病与卫生统计学系，北京100191
2
    中国医学科学院，北京，中国。
3
    临床试验服务单位和流行病学研究单位（CTSU），牛津大学纳菲尔德人口健康部，牛津，英国。
4
    湖南省疾病预防控制中心，湖南长沙。
五
    柳州市中医院，广西柳州。
6
    柳州市疾病预防控制中心，广西柳州。
7
    中国国家食品安全风险评估中心，中国北京。
8
    北京市学院路38号北京大学医学部公共卫生学院流行病与卫生统计学系，北京100191 [email protected]。
9
    北京大学环境医学研究所，北京，中国。 [email protected]。

抽象
背景：

关于慢性乙型肝炎病毒（HBV）感染与慢性肾病（CKD）风险之间的关联，现有证据尚无定论。我们前瞻性研究了慢性HBV感染与CKD风险之间的关系，以及HBV感染与已确定的几种生活方式因素和流行疾病对CKD风险的风险因素的联合关联。
方法：

来自中国嘉道理生物库的参与者在2004 - 2008年间入选，并且随访至2015年12月31日。排除了先前诊断为CKD，癌症，心脏病和中风的参与者后，本研究包括469,459名参与者。在基线时定性测试乙型肝炎表面抗原（HBsAg）。事件CKD病例主要通过健康保险系统和疾病与死亡登记处确定。
结果：

在平均随访9.1年（420万人年）期间，我们记录了4555例CKD事件。 Cox回归得出多变量校正风险比（HRs）和95％置信区间（CIs）。与HBsAg阴性受试者相比，HBsAg阳性受试者的CKD多变量校正HR（95％CI）为1.37（1.18,1.60）。男性的关联性更强（HR = 1.77; 95％CI：1.43,2.20）高于女性（HR = 1.10; 95％CI：0.88,1.36）。 HBsAg阳性参与者，无论是否伴有肝炎或肝硬化，无论是否正在接受治疗，均显示出发生CKD的风险增加。我们观察到HBsAg阳性与吸烟，缺乏身体活动或糖尿病对CKD风险有积极的加性相互作用。与HBsAg阴性参与者为非吸烟者，体力活跃或在基线时没有糖尿病相比，HBsAg阳性参与者的最大CKD风险为吸烟者（HR = 1.85; 95％CI：1.44,2.38） ，身体无活性（HR = 1.91; 95％CI：1.52,2.40）或糖尿病（HR = 6.11; 95％CI：4.47,8.36）。
结论：

在HBV感染高流行的国家，与慢性HBV感染相关的肾损害应该是不可忽视的问题。我们的研究结果还强调健康咨询对戒烟，增加体育活动，改善血糖控制以及早期筛查慢性HBV感染者CKD的重要性。
关键词：

慢性乙型肝炎病毒感染;慢性肾病;前瞻性队列研究

结论：
    29909773
DOI：
    10.1186 / s12916-018-1084-9