B C ALT B C B B C

Transcription

1 ( Hepatitis surface antigen, HsAg ) ( Anti-hepatitis virus antibody anti-hv ) ( alanine transaminase ) (n=56702; / : 17551/39151) HsAg anti-hv 40 IU/L (standardized morbidity ratio; ) 13 HsAg anti-hv 10.9% 10.2% 12.8% 28.0 (7/25) 0% 2 9 < (38/42) 12 0% <

2 (23/42) 41.0 (18/44) 0.0 (0/53) 2 15 < ( Hepatitis surface antigen, HsAg ) ( Anti-hepatitis virus antibody, anti-hv ) ( Alanine transaminase ) ( Geographic variation ) ( Prevalence ) ( Hepatitis surface antigen, HsAg ) 15-20% 4,

3 278 HsAg ( Anti-hepatitis virus antibody anti-hv ) ( Alanine transaminase ) 1,105, , HsAg anti-hv Hitachi 747 ( Hitachi Ltd., Tokyo, Japan ) 40 IU/L 40 IU/L HsAg enzymelinked immunoassay ( ELISA ) SURASE -96 plate anti-hv ( ELISA ) SP- NANASE plate ( ) 533 HsAg () ( HsAg ) 2 ( ( 12 ) (9 ) ) (3 ) 1.5 ( ( 38 ) ( 21 ) ) 21 ( (17 ) ) ( ( 190 ) ) (8 ) ( ( 182 ) ) ( 224 ) (6 ) ( ( 218 ) ) ( 56 ) (21 ) ( ) 21 ( (35 ) ) 35 HsAg 4 0.0% HsAg (10.9%) anti-hv (10.2%) (12.8%)

4 (n=50) 1 1.5(n=190) 0.5 1(n=224) 0.5(n=56) (n=13) HV anti-hv HsAg anti HsAg anti-hv HsAg anti- HV ( 1 ) ( standardized morbility ratio ) HsAg anti- HV 10.9% 10.2% 12.8% ( n=1 ) ( n=3 ) ( n=5 ) ( n=6 ) ( n=8 ) ( n=9 ) ( n=520 ) HsAg anti-hv

5 significant 0.5 significant 13 (0.0%) (24.1%) 10 HsAg % ( 7/25 ) 0.0% 14 ( ) > > 1 190

6 > ( 24.1% ) ( 0.0% ) 10 () ( Anti-HV ) 2 (P 0.05) ( 69 ) ( 69 ) ( ) (P 0.05) ( ( 32 ) (20 ) ) 20 ( (12 ) ) ( 58 ) ( ( 58 ) ) ( ( 162 ) (P 0.05) ) (14 ) ( (148 ) ) (P 0.05) ( ( 199 ) ( 118 ) ) ( ) 118 ( (81 ) ) 81 Anti-HV 50% 8 Anti-HV 0.0% 12 HsAg (10.9%) anti-hv (10.2%) (12.8%)

7 282 Anti-HV % ( 38/42 ) 81.8% ( 36/44 ) 75.6% ( 96/127 ) 62.8% ( 113/180 ) 8 50% 0.0% % 2> > > Anti-HV ( 42.3% ) HsAg 414 ( 79.6% ) ( P ) ( ) (P 0.05) 12 ( P ) 1.5 (n=101) (n=58) (n=162) 0.5 (n=199) (n=13) ( P ) ( P=0.001 )

8 significant 0.5 significant 13 (0.0 )- - (25.3%)

9 284 () ( ) 2 (P 0.05) ( 15 ) ( 15 ) 1.5 (P 0.05) ( ( 41 ) ( 20 ) ) 20 ( (21 ) ) ( 169 ) (P 0.05) 4 ( ( 165 ) ) ( ( 247 ) (P 0.05) ) 5 ( (242 ) ) (P 0.05) ( ( 48 ) (18 ) ) 18 ( (30 ) ) 30 40% 2 0.0% (0/53) (P 0.005) HsAg (10.9%) anti-hv (10.2%) (12.8%) ( ( 25.3% ) - ( 0.0% ) - ) ( % ( 23/42 ) 41.0% ( 18/44 ) 0.0% ( 0/53 ) > > > ( 80% ) > anti-hv ( 88.6% ) HsAg 1.5

10 285 3 ( 8.6% ) anti-hv 1.5 ( P 0.05 ) ( anti-hs ) 1.5 (n=56) (n=169) (n=247) 0.5 (n=48) (n=13)

11 e ( HeAg ) HsAg (24.1%)(7/29) (0.0%)(0/44) HsAg 24 ( 90.5% ) ( 38/42 ) ( 1.6% ) ( 1/63 ) anti-hv 56 1~2% 90% 7,8

12 ,21,27 sampling error , % ( n=56702 ) 11%

13 288 hepatitis virus infection in Taiwan. hinese Journal of Gastroenterology 1984; 1: hen DS, Sung JL. Hepatitis virus infection on Taiwan [Letter]. N Engl J Med 1977; 297: Ni YH, hang MH, Huang LM, et al. Hepatitis virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis vaccination. Ann Intern Med 2001; 135: ( MRP8032 ) 1 DOH90-HP-1001 ( DOH92-HP-2503 ) 31 1.Hayashi PH, Di isceglie AM. The progression of hepatitis - and -infections to chronic liver disease and hepatocellular carcinoma: epidemiology and pathogenesis. Med lin North Am 2005; 89: easley RP. Hepatitis virus: The major etiology of hepatocellular carcinoma. ancer 1988; 61: Yu MW, hen J. Hepatitis and viruses in the development of hepatocellular carcinoma. rit Rev Oncol Hematol 1994; 17: Sung JL, hen DS, Lai MY, et al. Epidemiological study of 1999; 18: Wang JH, Lu SN, Wu J, et al. A hyperendemic community of hepatitis virus and hepatitis virus infection in Taiwan. Trans Royal Socie Tropic Med Hyg 1999; 93: Lu SN, Wang JH, Kuo YK, et al. Predicting the prevalence of anti-hv in a community using the prevalence of alanine transaminase () elevation a method to identify HV-endemic areas. Am J Trop Med Hyg 2002; 67: Lu SN, Su WW, hen H, et al. Secular trends and geographic variations of hepatitis virus and hepatitis virus-associated hepatocellular carcinoma in Taiwan. Int J ancer 2006 (in press). 11.hen J, huang Y, You SL, Lin TM, Wu HY. A retrospective study on malignant neoplasms of bladder, lung and liver in blackfoot disease endemic area in Taiwan. r J ancer 1986 ; 53: Lu SN, hen J. Prevalence of hepatitis surface antigen carrier status among residents in the endemic area of chronic arsenicism in Taiwan. Anticancer Res 1991; 11: hang WY, hen J, Lu SN, et al. Relationship between fatty liver, alanine aminotransferase, HsAg and hepatitis virus. J Gastroenterol Hepatol 1992; 7: doh.gov.tw/statistic/data/ /93.htm 15.hang MH, hen J, Lai MS, et al. Universal hepatitis vacciantion in Taiwan and incidence of hepatoma in children. N Eng J Med 1997; 336: hen HL, hang MH, Ni YH, et al. Seroepidemiology of hepatitis virus infection in children: ten years of mass vaccination in Taiwan. JAMA 1996; 276: Alter MJ, Margolis HS, Krawczynski K, et al. The natural history of community-acquired hepatitis in the United States. N Eng J Med 1992; 327: hen DS. From hepatitis to hepatoma: lesons from type viral hepatitis. Science 1993; 262: Lu SN, hue PY, hen H, et al. Different Viral Etiology of Hepatocellular arcinoma between Two Hepatitis and Endemic Townships in Taiwan. J Gastroenterol Hepatol 1997; 2: Wu JS, Lu F, hou WH, et al. High prevalence of hepatitis virus infection in aborigines in Taiwan. Jpn J Med Sci iol 1992; 45: ; 17:

14 Sun A, hen H, Lu SN, et al. Persistent hyperendemicity of hepatitis virus infection in Taiwan: the important role of iatrogenic risk factors. J Med Virol 2001; 65: Wang S, hang TT, Yao WJ, et al. omparison of hepatitis virus and hepatitis virus prevalence and risk factors in a community-based study. Am J Trop Med Hyg 2002; 66: Wang S, hang TT, hou P. Differing characteristics of hepatitis and risks factors among elders in a rural area in Taiwan. J Gerontol A iol Sci Med Sci 1998; 53: Lu SN, hue PY, hen IL, et al. Incidence of hepatitis infection in a hepatitis endemic township in southern Taiwan. Kaohsiung J Med Sci 1997; 13: hang MH. Hepatitis virus infection in children: epidemiology, natural course and prevention in Taiwan. J Formos Med Assoc 1996; 95: Wang S,Wang ST, hou P.Using the prevalence of an elevated serum alanine aminotransferase level for identifying communities with a high prevalence of hepatitis virus infection. Arch Intern Med 2001; 161: Lu SN, Lee M, hangchien S, hen J. Excess mortality from hepatocellular carcinima in an HV-endemic Township of an HV-endemic country. Trans Royal Socie Tropic Med Hyg 1999; 93: Village Distribution and Geographic Variations of the Prevalence of hronic Hepatitis, and Hypertransaminemia: an Analysis of Adult Health Examinations in 520 Villages of Tainan ounty, Taiwan Pao-Fei hen 1, Kwong-Ming Kee 1,2, Yao-Der hen 3, Lin-San Tsai 3, Lin-yi Shih 4, Li-hu Lin 3,5, Hsiu-Hsi hen 6, and Sheng-Nan Lu 1,2 1 Division of Hepatogastroenterology, hang Gung Memorial Hospital-Kaohsiung Medical enter; 2 hang Gung University ollege of Medicine, Kaohsiung,Taiwan; 3 Tainan ounty Health ureau, Sinying, Tainan; 4 ureau of Health Promotion, Department of Health, Executure Yuan; 5 Zuojhen Township Health Station, Tainan ounty; and 6 Institute of Preventive Medicine, National Taiwan University School of Public Health. ackground and Aims: hronic hepatitis virus (HV) and hepatitis virus (HV) infection are the two major causes of liver disease deaths in Taiwan. The impact of HV infection has increased since the effective prevention of HV infection. Epidemiologic studies of HV, in comparison with HV, have hither to been incomplete in Taiwan. Previous studies for the prevalence of HV were limited to small-scale community studies, and no large-scale community studies for the screening of HV and HV have been published before. The purpose of this study is to investigate the prevalence of H surface antigen (HsAg), anti-hv antibody (anti-hv) and hypertransaminemia levels in villages in Tainan county, and to analyze geographic variations among villages

15 290 throughout the whole county. Patients and Methods: Health examinations were carried out by the Health ureau of Tainan ounty in 533 villages in Tainan county between April and November Residents aged >40 years (n=56702; men/women:17551/39151) were invited for a series of examinations, including HsAg, anti-hv and alanine transaminase (). The upper normal limit of levels is 40 IU/L. Standardized morbidity ratio () was used to analyse prevalences of HsAg, anti-hv and hypertransaminemia in village levels of Tainan county. The method is prevalences of HsAg, anti-hv and hypertransaminemia in village levels were divided by overall prevalences of these three parameters respectively. Goodness-of-fit test for chi-square was used to test the significance difference between the prevalences. A total of 13 villages were excluded because the number of subjects enrolled was not sufficient for the chi-square test. Results: The overall prevalence of HsAg, anti- HV and hypertransaminemia was 10.9%, 10.2% and 12.8% respectively. In village-specific prevalences of HsAg, the highest prevalence was in Jianan village (Guantian Township) (28.0, 7/25), and the lowest prevalences were found in Kanping village (igu Township), hungjung village (Anding Township), hinsha village (Sigang Township) and Shichao village (Longci Township), (all at 0%). There were nine villages with significant levels of ( 2), and 21 villages with significant levels of (<0.5). For anti-hv, the highest prevalence was in Shuiyu village (Dongshan Township) (90.5, 38/42), where as a total of 12 villages had 0% prevalence. There were 69 villages with statistically significant levels of ( 2) and 8 villages which had prevalence rates of more than 50%. 118 villages had significant levels of (<0.5). The numbers of high or low prevalence of HV was much greater than for HV. In prevalence of hypertransaminemia, the highest prevalence was in Shuiyu village (Dongshan Township) (54.8, 23/42), followed by Nanhsi village (41.0, 18/44). The lowest prevalence was in Tachou village (Hsinshih Township) (0, 0/53). There were 15 villages with significant levels of ( 2), and 18 villages with significant levels of (<0.5). The distributions of high and low prevalence of hypertransaminemia were similar to the prevalence of anti-hv. Prevalence of anti-hv at village level showed great diversity among each township. There was a high prevalence of anti-hv in only a few villages in a township, but there were also all villages in a township. onclusions: This study provides complete data for HV, HV and hepatitis in every village in Tainan ounty, and describes their geographic variations and distribution patterns. This important information should prove important to workers in public health. ( J Intern Med Taiwan 2006; 17: )