乙型肝炎疫苗接种时代高发区肝细胞癌的危险因素变化

StephenW

Changing Risk Factors for Hepatocellular Carcinoma in Hyperendemic Regions in the Era of Universal Hepatitis B Vaccination
Xue-Yan Wang  1 , Jin-Mei Huang  1 , Xue-Ming Lu  2 , Tim J Harrison  3 , Hua-Bing Liu  4 , Hui-Hua Jia  4 , Zhong-Liao Fang  5
Affiliations

    PMID: 32623359 DOI: 10.1016/j.canep.2020.101775

Abstract

Background: LongAn, Guangxi, was the first county in China to implement universal childhood hepatitis B virus (HBV) immunization. We aimed to determine its long-term effects in preventing hepatocellular carcinoma (HCC) 32 years after the immunization programme was launched.

Methods: Information on HCC deaths for LongAn and its neighbouring county, BinYang (where universal hepatitis B vaccination was not started till 2002), were obtained from the national mortality surveillance system. The data were analysed using Poisson regression.

Results: The overall age-adjusted mortalities of HCC in LongAn and BinYang during 2017-2018 were 53.3/100,000 and 45.4/100,000, respectively. The mortality of males aged 20-29 years in LongAn, who were vaccinated at birth, was lower (2.7/100,000, 95%CI 0.8-4.5) than that of males in BinYang, who were not vaccinated (4.7/100,000, 95%CI 3.2-6.3). In LongAn, the HCC mortality in adults aged 20-29 years declined significantly from 7.9/100,000 (95%CI 4.4-11.4) in 2004 to 1.4/100,000 (95%CI 0.4-2.4) in 2017-2018 (χ2 = 5.554, p = 0.018). Among those vaccinated at birth, the HCC mortality in mountainous areas, where dietary exposure to aflatoxins is more common, is higher (9.0/100,000, 95%CI 4.5-13.5) than in low-lying areas (6.5/100,000, 95%CI 3.6-9.4) (χ2 = 0.2393, p = 0.618).

Conclusion: Immunization of infants against HBV has reduced their risk of developing HCC as children and young adults but could not prevent all cases of HCC, suggesting that the major risk factor for HCC in hyperendemic regions is shifting from HBV to other factors. Additional prevention strategies for HCC will be needed in the future.

Keywords: Epidemiology; Hepatitis B immunization; Hepatocellular carcinoma; Long-term effects; Risk factor.

Copyright © 2020 Elsevier Ltd. All rights reserved.

StephenW

乙型肝炎疫苗接种时代高发区肝细胞癌的危险因素变化
王雪岩1，黄金梅1，卢雪明2，蒂姆·哈里森3，刘华兵4，贾慧华4，房中辽5
隶属关系

    PMID：32623359 DOI：10.1016 / j.canep.2020.101775

抽象

背景：广西隆安是中国第一个实施儿童普遍性乙型肝炎病毒（HBV）免疫的县。我们旨在确定其在免疫计划启动32年后对预防肝细胞癌（HCC）的长期影响。

方法：从国家死亡率监测系统中获得龙眼及其邻县宾阳（直到2002年才开始全面接种乙型肝炎疫苗）的HCC死亡信息。使用泊松回归分析数据。

结果：2017-2018年龙眼和滨阳区的HCC总体死亡率调整后的死亡率分别为53.3 / 100,000和45.4 / 100,000。龙安市出生时进行过疫苗接种的20-29岁男性的死亡率（2.7 / 100,000，95％CI 0.8-4.5）低于未接种疫苗的滨阳市男性（4.7 / 100,000，95％） CI 3.2-6.3）。在龙眼，20-29岁成年人的HCC死亡率从2004年的7.9 / 100,000（95％CI 4.4-11.4）大幅下降至2017-2018年的1.4 / 100,000（95％CI 0.4-2.4）（χ2= 5.554， p = 0.018）。在出生时接种疫苗的人群中，饮食中黄曲霉毒素暴露较常见的山区的HCC死亡率高于低洼地区（6.5 / 100,000，95％CI）的HCC死亡率（9.0 / 100,000，95％CI 4.5-13.5） 3.6-9.4）（χ2= 0.2393，p = 0.618）。

结论：婴儿接受HBV免疫降低了儿童和青年人发展HCC的风险，但不能预防所有HCC病例，这表明高流行地区HCC的主要危险因素正在从HBV转向其他因素。将来将需要针对HCC的其他预防策略。

关键词：流行病学；乙肝免疫接种；肝细胞癌；长期影响;风险因素。

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