基于启东的中国农村原发性肝癌发病危险因素及高危人群筛选分析的队列研究

Analysis of risk factors for primary liver cancer in rural China and high risk population identification:a cohort study in Qidong, China

目的筛选中国农村地区的肝癌发病高危人群。方法通过问卷调查的方式对2011年6月至2013年6月启东市人民医院检验科检出的乙肝表面抗原(HBs Ag)携带者进行调查。采用Cox比例风险回归模型分析肝癌发病的危险因素,并采用ROC曲线评估不同独立危险因素组合筛选肝癌发病高危人群的能力。结果共纳入1 296例研究对象,其中男性686例,平均年龄45.73±11.58岁,女性610例,平均年龄45.67±12.33岁,队列平均随访5.5年,新发肝癌43例,肝癌人年发病率为60.5百万人年。多因素Cox回归模型显示年龄增加[HR=1.055,95%CI(1.029,1.083),P<0.000 1]、男性[HR=3.263,95%CI(1.567,6.796),P=0.001 6]、有肝癌家族史[HR=2.315,95%CI(1.260,4.252),P=0.006 8]、乙肝e抗原(HBe Ag)阳性[HR=2.367,95%CI(1.267,4.419),P=0.006 9]及γ-谷氨酰转肽酶(GGT)升高[HR=2.721,95%CI(1.457,5.083),P=0.001 7]为肝癌发病的独立危险因素。结论临床常规宿主、病毒及肝功指标组合,能够有效筛选并辨识我国农村HBs Ag携带者中的肝癌高危群体。

Objectives To classify the high risk population for primary liver cancer（PLC） in rural China.Methods Between June 2011 and June 2013, hepatitis B surface antigen（HBsAg） carriers were identified in clinical laboratory of Qidong People＇s Hospital and surveyed by questionnaires. Cox proportional hazard regression model was introduced to demonstrate independent risk factors associated with PLC occurrence. Moreover, receiver characteristic operating（ROC） curve was utilized to evaluate discrimination power of risk factor panel for PLC risk classification.Results A total of 1 296 HBsAg carriers were enrolled, among which 686 participants were male with an average age of45.73±11.58 years, and 610 participants were female with an average age of 45.67±12.33 years. After a mean follow up period of 5.5 years, 43 incident PLC cases were confirmed, which generated a PLC incidence of 60.5 millions person years.Multi-univariate Cox model showed that increase of age（HR=1.055, 95%CI 1.029 to 1.083, P〈0.000 1）, male（HR=3.263,95%CI 1.567 to 6.796, P=0.001 6）, having family history of PLC（HR=2.315, 95%CI 1.260 to 4.252, P=0.006 8）, HBe Ag positivity（HR=2.367, 95%CI 1.267 to 4.419, P=0.006 9） and GGT abnormality（HR=2.721, 95%CI 1.457 to 5.083, P=0.001 7）were the independent risk factors of PLC. Conclusion Routine host, viral and liver biochemical parameters which are readily accessible in daily clinical practice can be utilized in identification of the targeted population for prevention of PLC in rural China.