close

Вход

Забыли?

вход по аккаунту

?

73

код для вставкиСкачать
Int. J. Cancer: 71, 776–779 (1997)
r 1997 Wiley-Liss, Inc.
Publication of the International Union Against Cancer
Publication de l’Union Internationale Contre le Cancer
SEROPREVALENCES OF HEPATITIS B AND C VIRUSES AND HELICOBACTER
PYLORI INFECTION IN A SMALL, ISOLATED POPULATION AT HIGH RISK
OF GASTRIC AND LIVER CANCER
Shu-Yuan CHEN1, Tzeng-Ying LIU2, Meei-Jin CHEN2, Jaw-Town LIN3, Jin-Chuan SHEU3 and Chien-Jen CHEN1,*
1Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei 10018, Taiwan
2Health Bureau of Lienkiang County, Matzu
3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)
The objective of this study was to examine the seroprevalences of chronic infection with hepatitis B and C viruses and
Helicobacter pylori in Matzu, a group of small islets with 5,566
civilian residents who have extremely high mortality from
cancers of the stomach and liver. The standardized mortality
ratios (SMR) of all cancer sites combined, liver cancer and
stomach cancer in 1984–1993 were calculated using the
general population in Taiwan as the referent (SMR 5 100).
The SMRs (95% confidence interval) for all cancer sites
combined, liver cancer and stomach cancer were 160 (131–
195), 252 (170–360) and 351 (229–516), respectively, in Matzu.
A health survey was carried out with 1,485 civilian residents
aged 30 years or more, giving a reponse rate of 69% among
those who were eligible. Serum samples were tested for
antibodies against Helicobacter pylori (anti-HP) by enzymelinked immunosorbent assay and hepatitis B surface antigen
(HBsAg) and antibodies against hepatitis C virus (anti-HCV)
by enzyme immunoassay. The seroprevalence was 61% for
anti-HP, 24.7% for HBsAg and 1.8% for anti-HCV in Matzu.
While mortality rates of liver and stomach cancers were
significantly higher in Matzu than in Taiwan, the seroprevalences of anti-HP, HBsAg and anti-HCV in Matzu were similar
to or even lower than those in Taiwan. These findings suggest
the existence of risk factors other than microbial agents
involved in the development of stomach and liver cancers. Int.
J. Cancer 71:776–779, 1997.
r 1997 Wiley-Liss, Inc.
Stomach cancer is estimated to be the second most common
cancer in the world, in spite of its declining secular trend in nearly
all countries (Parkin et al., 1993) including Taiwan (Huang et al.,
1988). The incidence and mortality of stomach cancer still ranked
as sixth and third among leading cancer sites, respectively, in 1991
in Taiwan (Department of Health, 1995). Although several risk
factors such as blood type A, chronic gastric diseases, cigarette
smoking, alcohol drinking, green tea drinking, increased consumption of salted meat, cured meat, smoked food, fried food and
fermented beans, and lower consumption of milk have been
documented in Taiwan (Lee H.H. et al., 1990), their biological
significance remains unknown. After the successful culture of a
spiral-shaped organism known today as Helicobacter pylori (H.
pylori) (Marshall, 1983), many studies were carried out to examine
the association between H. pylori and stomach cancer. Previous
prospective epidemiological studies have shown a significant association between H. pylori and stomach cancer, with a relative risk ranging
from 2.8 to 6.0 (Forman et al., 1991; Parsonnet et al., 1991; Nomura et
al., 1991). An ecological correlation of stomach cancer mortality with
seroprevalence of antibodies against H. pylori (anti-HP) was also found
in China (Forman et al., 1990). However, only a moderate association
(p 5 0.3) was observed among 13 European populations (Eurogast
Study Group, 1993; Giesecke, 1993; Forman et al., 1993). In spite of
this body of evidence, the association between H. pylori infection and
stomach cancer remains controversial.
Liver cancer, chiefly hepatocellular carcinoma (HCC), is the
leading cancer in Taiwan where hepatitis B virus (HBV) is
hyperendemic with an infection rate of 85–90% and a chronic
hepatitis B surface antigen (HBsAg) carrier rate of 15–20%. The
HBsAg carrier status has been well documented as one of the most
important risk factors for HCC. The attributable risk percentage of
HBsAg carrier status has been estimated to be as high as 79%
(Chen et al., 1991) and the multivariate-adjusted relative risk of
developing liver cancer for HBsAg carrier status was 17.0 in a
cohort study of 13,737 male adults in Taiwan (Chen et al., 1993). In
addition to HBsAg, HCV is also an important viral agent for HCC.
The population-attributable risk percentage of developing liver
cancer for HCV was estimated as 3%, with a multivariate-adjusted
relative risk as high as 23.7 (Yu et al., 1991). In a nested
case-control study, after adjustment for HBsAg status and other
risk factors, the anti-HCV was significantly associated with the
development of liver cancer, showing a multivariate-adjusted
relative risk of 88.2 (Chang et al., 1994).
The Matzu islets are located near the north coast of Fukien
Province of mainland China and are separated from Taiwan island
by the Taiwan Strait. Being fortified islands on the frontier, they
have been governed by military administration since 1949. Transport between Taiwan and Matzu and the principal supplies of
foodstuffs from Taiwan were dependent on the military services up
to 1992. The civilian population in Matzu was 5,566 in 1994, with a
steady emigration to Taiwan island. Residents in Matzu are
engaged in fishery, farming, storekeeping and the civil service. As
the cultivable land is limited and natural resources are not abundant
in Matzu, most foodstuffs are imported from Taiwan island. The
residents are reported to have a high mortality from cancers of the
stomach and liver; the reasons for this increased mortality remain
to be elucidated. The specific aim of this study was to examine the
mortality from stomach and liver cancers and the seroprevalences
of HBsAg, anti-HCV and anti-HP in Matzu. Another aim was to
compare the seroprevalences of anti-HP, HBsAg and anti-HCV in
Matzu with those reported in Taiwan.
MATERIAL AND METHODS
Mortality analysis
In Taiwan and Matzu, it is mandatory to register any event of
birth, death, marriage, divorce, migration, education and occupation in the household registration offices, so the death certificate
registry is quite complete. Death certificates of residents who died
from cancers during 1984–1993 were collected from Matzu
household registration offices. All the death certificates of Matzu
were reviewed and coded for their underlying causes of death
according to the Ninth Revision of the International Classifications
of Diseases, Injuries and Causes of Death (ICD-9, World Health
Organization, 1977), as in Taiwan. Mid-year populations by age
and sex in Matzu were abstracted from demographic reports of the
local household registration offices. The age-adjusted mortality
Contract grant sponsor: Department of Health, Executive Yuan, Republic
of China
*Correspondence to: Chien-Jen Chen, Institute of Epidemiology, College of
Public Health, National Taiwan University, 1 Jen-Ai Road Section 1, Taipei
10018, Taiwan. Fax: 886 2 3511955. E-mail: [email protected]
Received 3 December 1996; revised 10 February 1997
HBV, HCV, H. PYLORI AND CANCERS OF STOMACH AND LIVER
rates of all cancer sites combined, liver cancer and stomach cancer
in Taiwan using the 1976 world population as standard population
were derived from the national death certification profile and
demographic data. In order to compare the cancer mortality rates in
Taiwan and Matzu, age-standardized mortality ratios (SMR) from
cancers in Matzu were also calculated using the general population
in Taiwan as the standard population (SMR 5 100). The 95%
confidence intervals for the SMR were obtained by the exact
method (Breslow and Day, 1987).
Seroprevalence survey
A health survey was carried out from July to August 1995 in 5
islets of Matzu including Nankan, Peikan, Tunging, East Chukuang
and West Chukuang. In this health survey, all civilian residents
aged 30 or more years old and living in Matzu during the period of
survey were invited to participate. No military personnel were
recruited. In all, 2,158 eligible civilian residents were invited to
participate, and 1,485 (69%) of them took part in the survey,
including 759 men and 726 women. Their mean age (6 standard
deviation) was 46.6 (6 12.8) years old. The sociodemographic characteristics of participants and non-participants were comparable.
Blood samples were collected from study subjects by venepuncture and centrifuged to separate and aliquot the serum samples.
They were shipped to the laboratory at National Taiwan University
on dry ice and stored at 270°C until examination.
Serum samples from Matzu were tested independently for the
presence of IgG anti-HP by enzyme-linked immunosorbent assay
using commercial kits (GAP-IgG ELISA test, Biomerica, Newport
Beach, CA). The antigen was an inactivated native antigen of H.
pylori. The serum samples were diluted 1:200. The secondary
antibody was a sheep anti-human IgG, conjugated to horseradish
peroxidase. The specimen was considered positive for IgG antibodies to H. pylori if its optical density value was greater than or equal
to the upper cut-off value, i.e., 20 units/ml in the calibration curve.
The IgG assay had a sensitivity of 99.4% and a specificity of 94.2%
based on the manufacturer’s information.
The anti-HP seroprevalence in Matzu was compared with those
observed in 3 townships (Peinan, Potzu, and Chutung) of Taiwan
island (Lin et al., 1995a). In this previous report, the anti-HP was
also examined by enzyme-linked immunosorbent assay using
commercial kits from a different manufacturer (HEL-p test, Amrad,
Abbotsford, Australia). The test had a sensitivity of 96% and a
specificity of 93%, according to the manufacturer’s information.
Serum samples from Matzu were also tested for HBsAg and
anti-HCV by enzyme immunoassay (EIA) using commercial kits
(Abbott, North Chicago, IL). The second-generation kits were used
for the EIA test of anti-HCV. All positive samples were re-tested by
the same method. Only repeatedly positive samples were considered anti-HCV-positive. The seroprevalences of HBsAg and antiHCV in Matzu were compared with those observed in a study
carried out in 7 townships (Paisa, Huhsi, Makung, Sanchi, Potzu,
Kaohsu and Chutung) in Taiwan (Chen et al., 1995). Both HBsAg
and anti-HCV in this previous report were tested by the same
methods and commercial kits.
The age-adjusted seroprevalences and their standard errors were
calculated for anti-HP, anti-HCV and HBsAg, using the 1995
population in Taiwan area as the standard population. The Pearson
correlation coefficients between the seroprevalences of HBsAg,
anti-HCV and anti-HP of study subjects in Matzu were calculated.
The significance levels are based on 2-sided significance tests.
RESULTS
Using the 1976 world population as the standard population, the
age-adjusted mortality rate from cancers of all sites combined in
Matzu, 1984–1993, was 169.6 per 100,000 as shown in Table I. The
SMR (95% confidence interval, CI) for all cancer sites combined
was 160 (131–195) compared with the general population in
Taiwan (SMR 5 100). The age-adjusted mortality rates from liver
777
TABLE I – STANDARDIZED MORTALITY RATIOS WITH 95% CONFIDENCE
INTERVALS FOR ALL CANCERS, LIVER AND STOMACH CANCER IN MATZU,
1984–1993
Cancer
(ICD codes)
Age-adjusted Age-adjusted
rate in Taiwan1 rate in Matzu2
All sites combined
(140–208)
Liver (155)
Stomach (151)
Standardized
mortality ratio3
Ratio
(95% confidence
interval)
102.5
169.6
160
(131–195)
19.9
11.9
53.2
43.0
252
351
(170–360)
(229–516)
1Age-adjusted mortality rate in 1982–1991 per 100,000 using 1976
world population as standard population.–2Age-adjusted mortality rate
in 1984–1993 per 100,000 using 1976 world population as standard
population.–3Age-specific mortality rates in Taiwan, 1982–1991 were
used as standard rates to calculate the standardized mortality ratio; i.e.,
SMR for each cancer in Taiwan is 100.
TABLE II – COMPARISON OF THE AGE-ADJUSTED SEROPREVALENCES OF
HELICOBACTER PYLORI INFECTION AMONG RESIDENTS AGED 30 OR MORE IN
TAIWAN AND MATZU
Area
Matzu
Taiwan
Peinan
Potzu
Chutung
Age-adjusted seroprevalence3
Age-adjusted
stomach cancer
mortality rate
Prevalence
(%)
(95% confidence
interval)
43.01
61.04
(57.5–64.5)
12.72
10.22
8.42
76.15
79.25
58.65
(64.5–87.8)
(67.8–90.5)
(45.1–72.1)
1Age-adjusted mortality rate in 1984–1993 per 100,000 using 1976
world population as standard population.–2Age-adjusted mortality rate
in 1982–1991 per 100,000 using 1976 world population as standard
population.–3Age-adjusted seroprevalences per 100 using 1995 population in Taiwan area, including Taiwan island, Penghu, Kinmen and
Matzu islets, as standard population, which was weighted for the
standard error of the age-adjusted seroprevalences.–4The age-adjusted
seroprevalence per 100 was calculated from the age-specific seroprevalence of Helicobacter pylori among residents aged 30 or more in
Matzu, 1995.–5The age-adjusted seroprevalence per 100 was calculated from the age-specific seroprevalence of Helicobacter pylori
among residents aged 30 or more in the 3 townships of Taiwan island,
according to data abstracted from Lin et al. (1995a).
and stomach cancers were 53.2 and 43.0 per 100,000 with SMRs
(95% CI) of 252 (170–360) and 351 (229–516), respectively.
Table II illustrates the age-adjusted mortality rates from stomach
cancer and age-adjusted seroprevalences of anti-HP in Matzu and 3
townships in Taiwan. The age-adjusted mortality rates from
stomach cancer were significantly higher in Matzu than in 3
townships in Taiwan. The age-adjusted rates were 43.0, 12.7, 10.2
and 8.4 per 100,000, respectively, in Matzu, Peinan, Potzu and
Chutung. However, the age-adjusted seroprevalence of anti-HP in
Matzu (61.0%) was only slightly higher than that in Chutung
(58.6%) and even lower than those in Peinan (76.1%) and Potzu
(79.2%).
Table III depicts the age-adjusted mortality rates from liver
cancer and age-adjusted seroprevalences of HBsAg and anti-HCV
among male residents in Matzu and 7 townships in Taiwan. The
highest age-adjusted liver cancer mortality rate was observed in
Matzu (90.0 per 100,000). The age-adjusted liver-cancer mortality
rates ranged from 19.6 to 81.1 per 100,000 in Taiwan. The
age-adjusted seroprevalence of HBsAg was significantly higher in
Matzu (29.6%) and Paisa (38.3%) than in 6 other townships in
Taiwan, ranging from 19.7% to 22.6%. While the ratio between the
highest and lowest liver cancer mortality rates was as high as 4.6
(90.0 vs. 19.6 per 100,000), the ratio between the highest and
lowest HBsAg seroprevalences was only 1.9 (38.3% vs. 19.7%).
The age-adjusted seroprevalence of anti-HCV was low in Kaoshu
(1.3%), Matzu (1.4%), and Makung (1.6%) and highest in Paisa
CHEN ET AL.
778
TABLE III – COMPARISON OF THE AGE-ADJUSTED SEROPREVALENCES OF HEPATITIS B SURFACE ANTIGEN (HBsAg)
AND ANTIBODY AGAINST HEPATITIS C VIRUS (ANTI-HCV) AMONG MALE RESIDENTS AGED 30–64 IN TAIWAN
AND MATZU
Area
Matzu
Taiwan
Paisa
Huhsi
Makung
Sanchi
Potzu
Kaoshu
Chutung
Age-adjusted
liver cancer
mortality rate
Age-adjusted seroprevalence3
HBsAg
Prevalence (%)
Anti-HCV
(95% CI)
Prevalence (%)
90.01
29.64
(22.7–36.5)
1.44
81.12
62.52
57.52
40.92
32.12
23.52
19.62
38.3 5
19.75
21.85
20.75
22.65
20.95
20.05
(27.3–49.4)
(13.4–25.9)
(18.8–24.7)
(14.2–27.3)
(18.0–27.2)
(16.6–25.2)
(17.2–22.8)
18.35
5.45
1.65
11.85
7.35
1.35
2.35
HBsAg/Anti-HCV
(95% CI)
Prevalence (%)
(95% CI)
(0.0–3.2)
30.74
(23.7–37.7)
(10.5–26.1)
(1.3–9.5)
(0.4–2.8)
(5.0–18.5)
(4.0–10.6)
(0.0–2.5)
(1.3–3.4)
48.85
23.55
23.15
29.65
28.95
22.05
22.15
(37.5–60.2)
(16.6–30.5)
(20.0–26.2)
(21.4–37.9)
(23.7–34.0)
(17.5–26.4)
(19.2–25.0)
1Age-adjusted mortality rate among males in 1984–1993 per 100,000 using 1976 world population as
standard population.–2Age-adjusted mortality rate among males in 1982–1991 per 100,000 using 1976
world population as standard population.–3Age-adjusted seroprevalences per 100 using 1995 male
population in Taiwan area, including Taiwan island, Penghu, Kinmen and Matzu islets, as standard
population, which was weighted for the standard error of the age-adjusted seroprevalences.–4The
age-adjusted seroprevalence per 100 was calculated from the age-specific seroprevalences of HBsAg,
anti-HCV and seropositivity of HBsAg and/or anti-HCV among male residents aged 30–64 in Matzu,
1995.–5The age-adjusted seroprevalence per 100 in the 7 townships of Taiwan island was calculated from
the age-specific seroprevalences of HBsAg, anti-HCV and seropositivity of HBsAg and/or anti-HCV
among male residents aged 30–64, according to data abstracted from Chen et al. (1995).
(18.3%). The highest prevalence of seropositivity of HBsAg and/or
anti-HCV was in Paisa (48.8%). The ratio between the highest and
lowest prevalence of seropositivity of HBsAg and/or anti-HCV
was 2.2.
The associations between the seroprevalences of HBsAg, antiHCV and anti-HP among civilian residents aged 30 or more in
Matzu were analyzed, but no significant correlations were observed
(r 5 20.002 for anti-HP vs. HBsAg; r 5 20.019 for anti-HP vs.
anti-HCV; r 5 20.029 for HBsAg vs. anti-HCV).
DISCUSSION
Death certificates in Matzu were not included in the national
vital statistics before 1994, but it is mandatory to register any death
event in the household registration offices in Matzu, as in Taiwan.
In this study, we found that cancers of the liver and stomach were
the 2 leading cancers in Matzu. The age-adjusted mortality rates
were significantly higher in Matzu than in Taiwan. The difference
in mortality rates between Matzu and Taiwan could not be due to
the survival difference, because the 2 cancers had a very poor
prognosis in both Matzu and Taiwan (Lee C.S. et al., 1986; Wu et
al., 1994).
No association between H. pylori infection and mortality rates of
stomach cancer was observed in this study. The lack of association
in this study may be due to the high prevalence of H. pylori in
Matzu and Taiwan. Recent prospective studies also showed an
apparent lack of association in China (Webb et al., 1996). A nested
case-control study also failed to observe a significant odds ratio for
the association between H. pylori and stomach cancer (Lin et al.,
1995b). Besides the Chinese, there are several populations with
high H. pylori infection rates yet relatively low rates of gastric
cancer in Africa (Holcombe, 1992). The stomach-cancer risk was
quite different in various areas of Italy, but the seroprevalences of
anti-HP among adults were similar (Palli et al., 1993). No
correlation between stomach cancer risk and seroprevalence of
anti-HP among children and adolescents was observed in Costa
Rica (Sierra et al., 1992). These results suggest the existence of
other major risk factors involved in the etiology of stomach cancer
in addition to H. pylori infection in Matzu. Dietary factors, such as
excessive salt intake, preserved food consumption, exposure to
nitroso-compounds, and low consumption of fresh fruits and
vegetables may play important roles in gastric carcinogenesis in
Matzu, since cultivable land and natural resources are limited.
Further elucidation of these risk factors for stomach cancer in
Matzu and assessment of the interaction between these risk factors
and H. pylori infection are important for elucidation of the possible
mechanisms of gastric carcinogenesis.
In this study, despite the strikingly higher liver cancer mortality
rate in Matzu than in Taiwan, the seroprevalence of HBsAg was
only slightly higher in Matzu than in Taiwan. The seroprevalence
of anti-HCV in Matzu was even lower than in Taiwan. Combining
the seroprevalence of HBsAg and anti-HCV, residents in Matzu
still had only a slightly higher seropositive rate than those in
Taiwan. This finding is consistent with those of previous studies. In
Taiwan, the mortality rate of liver cancer is significantly higher in
mountainous aboriginal areas, the Penghu islets, and the endemic
area of arseniasis; but the HBsAg carrier rates were similar or
slightly higher among residents in these areas than in the general
population of Taiwan (Lu and Chen, 1991; Wang et al., 1993; Chen
et al., 1995). Our findings indicate that HBV may be important in
the etiology of liver cancer, but major risk factors other than HBV
and HCV are responsible for the high liver-cancer mortality in
Matzu.
In addition to HBV and HCV, aflatoxin exposure, low consumption of vegetables and low serum levels of retinol, cigarette
smoking and habitual alcohol drinking have been documented as
major risk factors for liver cancer in Taiwan (Hatch et al., 1993;
Chen et al., 1991, 1993, 1996b; Yu et al., 1995b). Foodstuffs in
Matzu are either stored for months before consumption or preserved as salted, pickled, fermented or nitrated foods. As the supply
of fresh vegetables and fruit in Matzu has been far from adequate, it
is suspected that the intake of micronutrients may be low among
residents in Matzu. A recent study has demonstrated the combined
effects of aflatoxin exposure and HBsAg carrier status on the
development of hepatocellular carcinoma in Taiwan (Wang et al.,
1996). Another study has shown a dose-response relation between
the level of serum aflatoxin-albumin adducts and risk of HCC
among subjects with null genotypes of glutathione S-transferase
(GST) M1 and/or T1, but not among those with non-null genotypes
(Chen et al., 1996a). Whether residents in Matzu have a higher
prevalence of null genotypes of GST M1 and T1 deserves further
investigation. Genetic polymorphism of CYP2E1 was found recently to modify the risk of cigarette-smoking-related hepatocarcin-
HBV, HCV, H. PYLORI AND CANCERS OF STOMACH AND LIVER
ogenesis (Yu et al., 1995a). Whether genetic susceptibility is also
involved in the development of HCC in Matzu remains to be
elucidated.
H. pylori may predispose residents in Matzu to a high risk of
stomach cancer through its ability to induce chronic atrophic
gastritis which may lead to subsequent gastrocarcinogenesis from
intestinal metaplasia and dysplasia to stomach cancer. HBV and
HCV may cause chronic active or persistent hepatitis, liver
cirrhosis and liver cancer in stepwise pathways. In the multistage
779
carcinogenesis of the stomach and liver, environmental co-factors
other than microbial agents may play roles in the initiation,
promotion or progression of these 2 cancers.
ACKNOWLEDGEMENTS
This study was supported by grants from the Department of
Health, Executive Yuan, Republic of China.
REFERENCES
BRESLOW, N.E. and DAY, N.E., Statistical methods in cancer research. Vol.
II, The design and analysis of cohort studies, pp. 69–70, World Health
Organization, Geneva (1987).
CHANG, C.C., YU, M.W., LU, C.F., YANG, C.S. and CHEN, C.J., A nested
case-control study on association between hepatitis C virus antibodies and
primary liver cancer in a cohort of 9,775 men in Taiwan. J. med. Virol., 43,
276–280 (1994).
CHEN, C.J., YU, M.W., LIAW, Y.F., WANG, L.W., CHIAMPRASERT, S., MATIN,
F., HIRVONEN, A., BELL, D.A. and SANTELLA, R.M., Chronic hepatitis B
carriers with null genotypes of glutathione S-transferase M1 and T1
polymorphisms who are exposed to aflatoxin are at increased risk of
hepatocellular carcinoma. Amer. J. hum. Genet., 59, 128–134 (1996a).
CHEN, C.J., WANG, L.Y., LU, S.N., WU, M.H., YOU, S.L., ZHANG, Y.J.,
WANG, L.W. and SANTELLA, R.M., Elevated aflatoxin exposure and
increased risk of hepatocellular carcinoma. Hepatology, 24, 38–42 (1996b).
CHEN, C.J. and 14 OTHERS, Community-based hepatocellular carcinoma
screening in seven townships in Taiwan. J. Formos. med. Ass., 94, S94–102
(1995).
CHEN, C.J., YU, M.W., WANG, C.J., HUANG, H.Y. and LIN, W.C., Multiple
risk factors of hepatocellular carcinoma: a cohort study of 13,737 male
adults in Taiwan. J. Gastroenterol. Hepatol., 8, s83–87 (1993).
CHEN, C.J., LIANG, K.Y., CHANG, A.S., CHANG, Y.C., LU, S.N., LIAW, Y.F.,
CHANG, W.Y., SHEEN, M.C. and LIN, T.M., Effects of hepatitis B virus,
alcohol drinking, cigarette smoking and familial tendency on hepatocellular
carcinoma. Hepatology, 13, 398–406 (1991).
DEPARTMENT OF HEALTH, EXECUTIVE YUAN, REPUBLIC OF CHINA, Annual
report of cancer registration, 1991, p. 3, Department of Health, Executive
Yuan, Taipei (1995).
EUROGAST STUDY GROUP, An international association between Helicobacter pylori infection and gastric cancer. Lancet, 341, 1359–1362 (1993).
FORMAN, D., MOLLER, H. and COLEMAN, M., International association
between Helicobacter pylori and gastric cancer: authors’ reply. Lancet, 342,
120–121 (1993).
FORMAN, D., NEWELL, D.G., FULLERTON, F., YARNELL, J.W.G., STACEY,
A.R., WALD, N. and SITAS, F., Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective
investigation. Brit. med. J., 302, 1302–1305 (1991).
FORMAN, D., SITAS, F., NEWELL, D.G., STACEY, A.R., BOREHAM, J., PETO, R.,
CAMPBELL, T.C., LI, J. and CHEN, J., Geographic association of Helicobacter pylori antibody prevalence and gastric cancer mortality in rural China.
Int. J. Cancer, 46, 608–611 (1990).
GIESECKE, J.,International association between Helicobacter pylori and
gastric cancer. Lancet, 342, 120 (1993).
HATCH, M.C., CHEN, C.J., LEVIN, B., JI, B.T., YANG, G.Y., HSU, S.W., WANG,
L.W., HSIEH, L.L. and SANTELLA, R.M., Urinary aflatoxin levels, hepatitis-B
virus infection and hepatocellular carcinoma in Taiwan. Int. J. Cancer, 54,
931–934 (1993).
HOLCOMBE, C., Helicobacter pylori: the African enigma. Gut, 33, 429–431
(1992).
HUANG, Y.C., TSAI, S.F., LEE, S.S., HSU, K.H., YOU, S.L., LIN, T.M. and
CHEN, C.J., Epidemiologic characteristics of malignant neoplasms in
Taiwan: III. Stomach cancer. J. nat. publ. Hlth Ass. (ROC), 8, 176–188
(1988).
LEE, C.S., SUNG, J.L., HWANG, L.Y., SHEU, J.C., CHEN, D.S., LIN, T.Y. and
BEASLEY, R.P. Surgical treatment of 109 patients with symptomatic and
asymptomatic hepatocellular carcinoma. Surgery, 99, 481–490 (1986).
LEE, H.H., WU, H.Y., CHUANG, Y.C., CHANG, A.S., CHAO, H.H., CHEN, K.Y.,
CHEN, H.K., LAI, G.M., HUANG, H.H. and CHEN, C.J., Epidemiologic
characteristics and multiple risk factors of stomach cancer in Taiwan.
Anticancer Res., 10, 875–882 (1990).
LIN, J.T., WANG, L.Y., WANG, J.T., WANG, T.H. and CHEN, C.J., Ecological
study of association between Helicobacter pylori infection and gastric
cancer in Taiwan. Digest. Dis. Sci., 40, 385–388 (1995a).
LIN, J.T., WANG, L.Y., WANG, J.T., WANG, T.H., YANG, C.S. and CHEN, C.J.,
A nested case-control study on the association between Helicobacter pylori
infection and gastric cancer risk in a cohort of 9,775 men in Taiwan.
Anticancer Res., 15, 603–606 (1995b).
LU, J.N. and CHEN, C.J., Prevalence of hepatitis B surface antigen carrier
status among residents in the endemic area of chronic arsenicism in Taiwan.
Anticancer Res., 11, 229–234 (1991).
MARSHALL, B.J., Unidentified curved bacillus on gastric epithelium in
active chronic gastritis. Lancet, 1, 1273–1275 (1983).
NOMURA, A., STEMMERMANN, G.N., CHYOU, P-H., KATO, I., PEREZ-PEREZ,
G.I. and BLASER, M.J., Helicobacter pylori infection and gastric carcinoma
among Japanese Americans in Hawaii. New Engl. J. Med., 325, 1132–1136
(1991).
PALLI, D. and 13 OTHERS, Helicobacter pylori antibodies in areas of Italy at
varying gastric cancer risk. Cancer Epidemiol. Biomarkers Prev., 2, 37–40
(1993).
PARKIN, D.M., PISANI, P. and FERLAY, J., Estimates of the worldwide
incidence of eighteen major cancers in 1985. Int. J. Cancer, 54, 594–606
(1993).
PARSONNET, J., FRIEDMAN, G.D., VANDERSTEEN, D.P., CHANG, Y., VOGELMAN, J.H., ORENTREICH, N. and SIBLEY, R.K., Helicobacter pylori infection
and the risk of gastric carcinoma. New Engl. J. Med., 325, 1127–1131
(1991).
SIERRA, R., MUÑOZ, N., PEÑA, A.S., BIEMOND, I., VAN DUIJN, W., LAMERS,
C.B.H.W., TEUCHMANN, S., HERNANDEZ, S. and CORREA, P., Antibodies to
Helicobacter pylori and pepsinogen levels in children from Costa Rica:
comparison of two areas with different risks for stomach cancer. Cancer
Epidemiol. Biomarkers Prev., 1, 449–454 (1992).
WANG, L.Y., CHENG, Y.W., CHOU, S.J., HSIEH, L.L. and CHEN, C.J., Secular
trend and geographical variation in hepatitis A infection and hepatitis B
carrier rate among adolescents in Taiwan: an island-wide survey. J. med.
Virol., 39, 1–5 (1993).
WANG, L.Y. and 13 OTHERS, Aflatoxin exposure and risk of hepatocellular
carcinoma in Taiwan. Int. J. Cancer, 67, 620–625 (1996).
WEBB, P.M., YU, M.C., FORMAN, D., HENDERSON, B.E., NEWELL, D.G.,
YUAN, J.M., GAO, Y.T. and ROSS, R.K., An apparent lack of association
between Helicobacter pylori infection and risk of gastric cancer in China.
Int. J. Cancer, 67, 603–607 (1996).
WORLD HEALTH ORGANIZATION, International classification of disease:
manual of the international statistical classification of diseases, injuries,
and causes of death, 1975 revision, Vol. 1, World Health Organization,
Geneva (1977).
WU, M.S., LIN, J.T., LEE, W.J., YU, S.C. and WANG, T.H., Gastric cancer in
Taiwan. J. Formos. med. Ass., 93, S77–89 (1994).
YU, M.W., GLADEK-YARBOROUGH, A., CHIAMPRASERT, S., SANTELLA, R.M.,
LIAW, Y.F. and CHEN, C.J., Cytochrome P450 2E1 and glutathione
S-transferase M1 polymorphisms and susceptibility to hepatocellular
carcinoma. Gastroenterology, 109, 1266–1273 (1995a).
YU, M.W., HSIEH, H.H., PAN, W.H., YANG, C.S. and CHEN, C.J., Vegetable
consumption, serum retinol level, and risk of hepatocellular carcinoma.
Cancer Res., 55, 1301–1305 (1995b).
YU, M.W., YOU, S.L., CHANG, A.S., LU, S.N., LIAW, Y.F. and CHEN, C.J.,
Association between hepatitis C virus antibodies and hepatocellular carcinoma in Taiwan. Cancer Res., 51, 5621–5625 (1991).
Документ
Категория
Без категории
Просмотров
2
Размер файла
46 Кб
Теги
1/--страниц
Пожаловаться на содержимое документа