慢性乙型肝炎病毒感染和总体和原因特异性死亡率：一项针

StephenW

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Epidemiology
Research
Chronic hepatitis B virus infection and total and cause-specific mortality: a prospective cohort study of 0.5 million people

    Jiahui Si1, Canqing Yu1, Yu Guo2, Zheng Bian2, Ruogu Meng1, Ling Yang3, Yiping Chen3, Jianrong Jin4, Jingchao Liu4, Ziyan Guo5, Junshi Chen6, Zhengming Chen3, Jun Lv1,7, Liming Li1,2 on behalf of the China Kadoorie Biobank Collaborative Group

Author affiliations
Abstract

Objectives Chronic hepatitis B virus (HBV) infection is associated with a higher risk of liver diseases. Substantial uncertainty remains, however, about the associations of HBV infection with mortality from extrahepatic causes, especially from subtypes of cardiovascular diseases. We prospectively examined the association of chronic HBV infection with total and cause-specific mortality.

Design Population-based prospective cohort study.

Setting China Kadoorie Biobank in which participants from 10 geographically diverse areas across China were enrolled between 2004 and 2008.

Participants 475 801 participants 30–79 years of age without reporting major chronic diseases at baseline were enrolled. Hepatitis B surface antigen (HBsAg) was tested using an on-site rapid test strip at baseline.

Primary and secondary outcome measures Total and cause-specific mortality.

Results A total of 35 822 deaths were recorded during ~10 years of follow-up. In multivariable-adjusted analyses, compared with HBsAg-negative participants, HBsAg-positive participants had an increased risk of total mortality (HR=2.01, 95% CI: 1.91 to 2.12), which was higher in men (HR=2.16, 95% CI: 2.01 to 2.31) than in women (HR=1.74, 95% CI: 1.60 to 1.90). Presence of HBsAg was associated with increased mortality from liver cancer (1339 deaths, HR=13.95, 95% CI: 12.46 to 15.62), infections (410 deaths, HR=10.30, 95% CI: 8.21 to 12.94), digestive diseases (688 deaths, HR=6.83, 95% CI: 5.49 to 8.50), intracerebral haemorrhage (4077 deaths, HR=1.38, 95% CI: 1.14 to 1.68) and ischaemic heart diseases (4624 deaths, HR=1.31, 95% CI: 1.09 to 1.58). The positive association between HBsAg status and risk of death was stronger in participants younger than 50 years, smokers, physically active or non-hypertensive participants.

Conclusions Among Chinese adults, chronic HBV infection was associated with increased mortality from a range of hepatic and extrahepatic diseases.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2018-027696

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Strengths and limitations of this study

    In this Chinese population, besides the significantly increased risk of death from liver cancer, infections and digestive diseases, we observed an increased risk of death due to intracerebral haemorrhage and ischaemic heart diseases associated with chronic hepatitis B virus (HBV) infection.

    The results highlight the importance of health advice on quitting smoking and early screening for major chronic diseases in people with chronic HBV infection.

    The prospective cohort design, large sample size and extended follow-up period allowed the present study to produce reliable risk estimates for total and various cause-specific mortality.

    We used an on-site hepatitis B surface antigen (HBsAg) rapid test that is convenient and repeatable but with low sensitivity for the lower sero-HBsAg level.

    Lack of information about specific treatment and other serologic markers of HBV infection also led to limitations of the present study.

StephenW

流行病学
研究
慢性乙型肝炎病毒感染和总体和原因特异性死亡率：一项针对50万人的前瞻性队列研究

    贾慧泗1，尹庆清1，余国2，郑卞2，蒙若谷1，凌阳3，陈一平3，金建荣4，刘景超4，王子燕5，陈俊士6，陈正明3，李俊1，李黎明1,2代表中国嘉道理生物银行协作组

作者隶属关系
抽象

目的慢性乙型肝炎病毒（HBV）感染与肝脏疾病的高风险相关。然而，关于HBV感染与肝外原因，尤其是心血管疾病亚型死亡率之间的相关性仍存在很大的不确定性。我们前瞻性地检查了慢性HBV感染与总死亡率和原因特异性死亡率之间的关系。

设计基于人群的前瞻性队列研究。

设置中国嘉道理生物银行，2004年至2008年期间，来自中国10个地理区域的参与者参加了此次活动。

参与者475 801名30-79岁参与者未报告基线时的主要慢性病。在基线使用现场快速测试条测试乙型肝炎表面抗原（HBsAg）。

主要和次要结局指标总死亡率和原因特异性死亡率。

结果在随访10年期间共录得35 822例死亡病例。在多变量调整分析中，与HBsAg阴性参与者相比，HBsAg阳性参与者的总死亡风险增加（HR = 2.01,95％CI：1.91-2.12），男性更高（HR = 2.16,95％） CI：2.01至2.31）比女性（HR = 1.74,95％CI：1.60至1.90）。 HBsAg的存在与肝癌死亡率增加有关（1339例死亡，HR = 13.95,95％CI：12.46~15.62），感染（410例死亡，HR = 10.30,95％CI：8.21~12.94），消化系统疾病（688例）死亡，HR = 6.83,95％CI：5.49至8.50），脑内出血（4077例死亡，HR = 1.38,95％CI：1.14至1.68）和缺血性心脏病（4624例死亡，HR = 1.31,95％CI：1.09）到1.58）。 HBsAg状态与死亡风险之间的正相关性在50岁以下的参与者，吸烟者，身体活动或非高血压参与者中更为强烈。

结论在中国成年人中，慢性HBV感染与一系列肝脏和肝外疾病的死亡率增加有关。

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http://dx.doi.org/10.1136/bmjopen-2018-027696

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本研究的优点和局限

    在这些中国人群中，除了肝癌，感染和消化系统疾病死亡风险显着增加外，我们观察到因慢性乙型肝炎病毒（HBV）感染引起的脑内出血和缺血性心脏病死亡的风险增加。

    结果强调了健康建议对戒烟和早期筛查慢性HBV感染者的主要慢性疾病的重要性。

    前瞻性队列设计，大样本量和延长的随访期使本研究能够对总体和各种原因特异性死亡率进行可靠的风险评估。

    我们使用现场乙型肝炎表面抗原（HBsAg）快速检测方便且可重复但对低血清HBsAg水平的敏感性较低。

    缺乏关于特定治疗和HBV感染的其他血清学标志物的信息也导致本研究的局限性。

StephenW

https://bmjopen.bmj.com/content/9/4/e027696?rss=1