血清乙型肝炎病毒DNA水平的生物学梯度与肝细胞肝癌的风险性相关

查看全文 作　　者：Chen C.-[1]J.;Yang H. -[2]I.;Su [2]J.;王铮(译)[2];陈云茹(校)[2] 机构地区：[1]National Taiwan University, No. 1, Jen-Ai Rd Sec.1, Taipei 10018, Taiwan, China;[2]不详 出　　处：《世界核心医学期刊文摘(胃肠病学分册)》索引2006年第2卷第6期,共1页 摘　　要：Context: Serum hepatitis B virus (HBV) DNA level is a marker of viral replication and efficacy of antiviral treatment in individuals with chronic hepatitis B. Objective: To evaluate the relationship between serum HBV DNA level and risk of hepatocellular carcinoma. Design, Setting, and Participants: Prospective cohort study of 3653 participants (aged 30-65 years), who were seropositive for the hepatitis B surface antigen and seronegative for antibodies against the hepatitis C virus, recruited to a community-based cancer screening program in Taiwan between 1991 and 1992. Main Outcome Measure: Incidence of hepatocellular carcinoma during follow-up examination and by data linkage with the national cancer registry and the death certification systems. Results: There were 164 incident cases of hepatocellular carcinoma and 346 deaths during a mean follow-up of 11.4 years and 41 779 person-years of follow-up. The incidence of hepatocellular carcinoma increased with serum HBV DNA level at study entry in a dose-response relationship ranging from 108 per 100 000 person-years for an HBV DNA level of less than 300 copies/mL to 1152 per 100 000 person-years for an HBV DNA level of 1 million copies/mL or greater. The corresponding cumulative incidence rates of hepatocellular carcinoma were 1.3%and 14.9%, respectively. The biological gradient of hepatocellular carcinoma by serum HBV DNA levels remained significant (P< .001) after adjustment for sex, age, cigarette smoking, alcohol consumption, serostatus for the hepatitis B e antigen (HBeAg), serum alanine aminotransferase level, and liver cirrhosis at study entry. The dose-response relationship was most prominent for participants who were seronegative for HBeAg with normal serum alanine aminotransferase levels and no liver cirrhosis at study entry. Participants with persistent elevation of serum HBV DNA level during follow-up had the highest hepatocellular carcinoma risk. Conclusion: Elevated serum HBV DNA level (>10 000 copies/mL) is a strong risk predictor of hepatocellular carcinoma independent of HBeAg, serum alanine aminotransferase level, and liver cirrhosis. 关 键 词：血清乙型肝炎病毒 DNA水平 肝细胞肝癌 风险性 乙型肝炎病毒(HBV) 生物学 梯度 丙氨酸氨基转移酶 慢性乙肝患者 HBV表面抗原阳性