血清乙型肝炎表面抗原阳性与食管癌关系的队列研究

The Relationship between Positive Serum HBsAg and Esophageal Cancer:A cohort Study.

目的探讨血清乙型肝炎表面抗原(HBsAg)阳性与食管癌发病的关系。方法应用队列研究方法对40岁以上HBsAg阳性队列(550例)和HBsAg阴性队列(881例)的非恶性肿瘤人群随访6年,分别计算观察人年数、食管癌、肝癌和其他恶性肿瘤的人年发病率、相对危险度(RR),并将两队列进行比较。结果6年内随访7740人年,HBsAg阳性队列2943.5人年,发现食管癌19例,人年发病率0.65%,HBsAg阴性队列4796.5人年,发现食管癌7例,人年发病率0.15%,两队列比较,P<0.01。RR4.42,95%可信区间1.62～12.06,归因危险度0.50%,归因危险度百分比77.36%,人群归因危险度百分比51.3%。分层分析显示,性别及年龄均不是混杂因素。肝癌在HBsAg阳性队列中的人年发病率明显高于HBsAg阴性队列(0.44%和0.04%,P<0.01;RR=10.52,95%可信区间为2.21～29.60)。其他恶性肿瘤的人年发病率在两队列间差异无显著性(0.58%和0.52%,P>0.05;RR=1.12,95%可信区间0.51～2.21)。结论血清HBsAg阳性与食管癌发病显著相关,乙型肝炎病毒不仅是原发性肝癌的致癌病毒,还可能是食管癌致癌病毒之一。

Objective To investigate the relationship between positive serum HBsAg and the occurrence of esophageal cancer. Methods A cohort study was applied to follow up the non-malignant tumor people(>40 years old) for 6 years, among which there were 550 subjects in positive serum HBsAg cohort, and 881 in negative serum HBsAg cohort. Number of follow-up person-year, the incidence and relative risk(RR) of esophageal cancer, primary hepatic carcinoma(PHC) and other malignant tumor were calculated and compared between the two cohorts. Results A total number of follow-up person-year was 7740, 2943.5 in positive cohort and 4796.5 in negative cohort. During the follow-up period, there were 19 new esophageal cancer cases in positive cohort and the person-year incidence was 0.65%, which was significantly higher than that in negative cohort(7 new cases, 0.15%)?穴P<0.01). RR was 4.42(95% CI 1.62-12.06), attributable risk (AR) Was 0.5% attributable risk proportion(AR%) was 77.36%, population attributable risk proportion(PAR%) was 51.3%. Stratified analysis showed that both age and sex were not confounding factors. The person-year incidence of PHC was higher in the positive serum HBsAg cohort than that in negative serum HBsAg cohort(0.44% vs 0.04%, P<0.01; RR=10.52, 95% CI 2.21-29.60). The person-year incidence of other malignant tumor was not significantly different between the two cohorts(0.58% vs 0.52, P>0.05; RR=1.12, 95% CI 0.51-2.21). Conclusion The occurrence of esophageal cancer was significantly associated with positive serum HBsAg. Hepatitis B virus(HBV) is not only the cause of primary hepatic carcinoma but may be one of the important risk factor for esophageal cancer.