Fine Particle Pollution, Alanine Transaminase, and Liver Cancer: A Taiwanese Prospective Cohort Study (REVEAL-HBV)
Fine Particle Pollution, Alanine Transaminase, and Liver Cancer: A Taiwanese Prospective Cohort Study (REVEAL-HBV)
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DOI：
10.1093/jnci/djv341
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发表时间：
2016-03-01
影响因子：
10.3
通讯作者：
Yang, Hwai-I
中科院分区：
文献类型：
--
作者：
Pan, Wen-Chi;Wu, Chih-Da;Yang, Hwai-I
背景：接触细颗粒物 (PM2.5) 可能通过低度炎症促进肝肿瘤发生。因此，我们评估了 PM2.5 长期暴露水平与随后发生肝细胞癌 (HCC) 风险的关联，并研究了以丙氨酸转氨酶 (ALT) 为代表的炎症对此关联的中介作用。 方法：1991 年至 1992 年间，我们在台湾招募了 23 820 名无 HCC 病史的参与者。 HCC 病例是通过计算机数据与国家癌症登记处和死亡证明系统的连接来确定的。参与者接触 PM2.5 的情况基于从固定监测点获取的四年平均值。 Cox 比例风险模型用于评估 PM2.5 暴露与 HCC 发病率之间的关联。评估了 ALT 对 PM2.5 相关 HCC 发病率的中介作用。结果：共有 464 例新诊断的 HCC 病例，中位随访时间为 16.9 年。在主岛和澎湖列岛观察到 PM2.5 暴露与 ALT 之间的统计显着增加趋势。每 PM2.5 四分位距 (IQR) 增量（0.73 A mu g/m(3)）暴露量，澎湖列岛 HCC 的调整后风险比 (HR) 为 1.22（95% 置信区间 [CI] = 1.02 至 1.47）。我们还发现 PM2.5 暴露（每 IQR 增量为 13.1 A mu g/m(3)）与主岛的 HCC 发病率呈正相关。此外，每增加 PM2.5 IQR，ALT 对 PM2.5 相关 HCC 发病率具有统计显着的中介作用（主岛 HR = 1.17，95% CI = 1.02 至 1.52；澎湖群岛 HR = 1.04，95% CI = 1.03 至 1.07）。结论：长期接触 PM2.5 会增加患肝癌和慢性炎症的风险。肝脏可能是发病机制的基础。
Background: Exposure to fine particulate matter (PM2.5) may promote hepatic tumorgenesis through low-grade inflammation. Therefore, we assessed the association of long-term exposure levels of PM2.5 and subsequent risk of hepatocellular carcinoma (HCC) and investigated the mediation effect of inflammation as represented by alanine aminotransferase (ALT) on this association.Methods: Between 1991 and 1992, we recruited 23 820 participants in Taiwan with no history of HCC. Case patients of HCC were ascertained through computerized data linkage with the National Cancer Registry and death certification systems. Participants' exposures to PM2.5 were based on a four-year average retrieved from stationary monitoring sites. Cox proportional hazards models were used to assess the association between PM2.5 exposure and HCC incidence. Mediation effects of ALT on PM2.5-associated HCC incidence were estimated.Results: A total of 464 HCC cases were newly diagnosed with a median follow-up of 16.9 years. Statistically significantly increasing trends between PM2.5 exposures and ALT were observed on the Main Island and Penghu Islets. The adjusted hazard ratio (HR) for HCC on the Penghu Islets was 1.22 (95% confidence interval [CI] = 1.02 to 1.47) per PM2.5 interquartile range (IQR) increment (0.73 A mu g/m(3)) exposure. We also found a positive association between PM2.5 exposure (per IQR increment, 13.1 A mu g/m(3) ) and HCC incidence on the Main Island. Furthermore, ALT had a statistically significant mediation effect on PM2.5-associated HCC incidence (HR = 1.17, 95% CI = 1.02 to1.52 on the Main Island; HR = 1.04, 95% CI = 1.03 to 1.07 on the Penghu Islets) per PM2.5 IQR increment.Conclusions: Long-term PM2.5 exposure increased the risk for liver cancer, and chronic inflammation of the liver may underlie the pathogenesis.