PLoS Med：新生儿乙肝疫苗接种可有效降低患肝癌风险

  近日，一项发表于国际杂志PLoS Medicine上的研究论文中，来自中国医学科学院的研究人员表示，新生儿进行乙型肝炎病毒疫苗的接种可有效降低中国年轻人肝癌及其它肝脏疾病的发病风险。
  文章中，研究者报告了启东乙肝干预研究的长期研究结果，这项研究是一项在江苏启东市从1983年至1990年开展的一项新生儿乙肝疫苗接种的随机控制实验，中国启动市是乙肝病毒相关原发性肝癌及其它肝脏疾病的高发地区；这项研究中，研究人员对41个乡镇，涵盖77658名新生儿随机接种乙肝疫苗进行干预，同时设对照组（不进行疫苗接种），同时对三分之二的对照组个体在其10至14岁时补种乙肝疫苗。
  基于肿瘤登记信息，研究人员对过去30年里的新发肝脏疾病患者的数据进行汇总分析，他们估计乙肝疫苗接种对原发性肝脏疾病的保护效力为84%（即疫苗接种可以减少84%的肝癌发病率），对免于肝脏疾病死亡的保护效力为70%，对新生儿急性重型肝炎的保护效力为69%。随后研究者又基于对1996-2000年及2008-2012年收集的HbsAg血清阳性率数据进行分析，他们发现，相比新生儿时期接种疫苗而言，青少年时期进行乙肝疫苗的补种对个体的保护效力相对较弱一些。
  这项研究同时也揭示了新生儿HBV疫苗接种对于保护个体后期免于患原发性肝癌及其它肝脏疾病的重要性；最后文章第一作者Chunfeng Qu说道，新生儿HBV疫苗的接种可以明显降低个体从儿童期至成年期的HbsAg血清阳性的流行，从而也会减少成年个体原发性肝癌及其它肝脏疾病的患病风险。本文的研究结果同时也表明，对于HbsAg阳性母亲所生的儿童应必须完成一系列新生儿的HBV疫苗接种程序。（转化医学网360zhyx.com）
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转化医学网推荐的原文阅读：

Efficacy of Neonatal HBV Vaccination on Liver Cancer and Other Liver Diseases over 30-Year Follow-up of the Qidong Hepatitis B Intervention Study: A Cluster Randomized Controlled Trial.
PLoS Medicine DOI: 10.1371/journal.pmed.1001774
Chunfeng Qu, Taoyang Chen, Chunsun Fan, Qimin Zhan, Yuting Wang, Jianhua Lu, Ling-ling Lu, Zhengping Ni, Fei Huang, Hongyu Yao, Jian Zhu, Jian Fan, Yuanrong Zhu, Zhiyuan Wu, Guoting Liu, Wenhong Gao, Mengya Zang, Dongmei Wang, Min Dai, Chu Chieh Hsia, Yawei Zhang, Zongtang Sun.
Background
Neonatal hepatitis B vaccination has been implemented worldwide to prevent hepatitis B virus (HBV) infections. Its long-term protective efficacy on primary liver cancer (PLC) and other liver diseases has not been fully examined.
Methods and Findings
The Qidong Hepatitis B Intervention Study, a population-based, cluster randomized, controlled trial between 1985 and 1990 in Qidong, China, included 39,292 newborns who were randomly assigned to the vaccination group in which 38,366 participants completed the HBV vaccination series and 34,441 newborns who were randomly assigned to the control group in which the participants received neither a vaccine nor a placebo. However, 23,368 (67.8%) participants in the control group received catch-up vaccination at age 10–14 years. By December 2013, a total of 3,895 (10.2%) in the vaccination group and 3,898 (11.3%) in the control group were lost to follow-up. Information on PLC incidence and liver disease mortality were collected through linkage of all remaining cohort members to a well-established population-based tumor registry until December 31, 2013. Two cross-sectional surveys on HBV surface antigen (HBsAg) seroprevalence were conducted in 1996–2000 and 2008–2012. The participation rates of the two surveys were 57.5% (21,770) and 50.7% (17,204) in the vaccination group and 36.3% (12,184) and 58.6% (17,395) in the control group, respectively. Using intention-to-treat analysis, we found that the incidence rate of PLC and the mortality rates of severe end-stage liver diseases and infant fulminant hepatitis were significantly lower in the vaccination group than the control group with efficacies of 84% (95% CI 23%–97%), 70% (95% CI 15%–89%), and 69% (95% CI 34%–85%), respectively. The estimated efficacy of catch-up vaccination on HBsAg seroprevalence in early adulthood was 21% (95% CI 10%–30%), substantially weaker than that of the neonatal vaccination (72%, 95% CI 68%–75%). Receiving a booster at age 10–14 years decreased HBsAg seroprevalence if participants were born to HBsAg-positive mothers (hazard ratio [HR] = 0.68, 95% CI 0.47–0.97). Limitations to consider in interpreting the study results include the small number of individuals with PLC, participants lost to follow-up, and the large proportion of participants who did not provide serum samples at follow-up.
Conclusions
Neonatal HBV vaccination was found to significantly decrease HBsAg seroprevalence in childhood through young adulthood and subsequently reduce the risk of PLC and other liver diseases in young adults in rural China. The findings underscore the importance of neonatal HBV vaccination. Our results also suggest that an adolescence booster should be considered in individuals born to HBsAg-positive mothers and who have completed the HBV neonatal vaccination series.