A nested case-control study on risk factors for development of adult T-cell leukemia/lymphoma among HTLV-I carriers

关于人类嗜T淋巴细胞病毒I型（HTLV-I）感染对健康的长期影响的纵向研究很少。作者对日本长崎的3,090名原子弹爆炸幸存者进行了一项HTLV-I感染和原因特异性死亡率的队列研究，这些人从1985-1987年到1995年被随访。男性和女性中HTLV-I血清阳性的患病率分别为99/1，196（8.3%）和171/1，894（9.0%）。在平均8.9年的随访期间，发生了448例死亡。有1例成人T细胞白血病/淋巴瘤非致死性病例（发生率=0.46例/1，000人-年; 95%置信区间[CI] 0.01-2.6）。在调整性别、年龄和其他潜在混杂因素后，HTLV-1携带者中观察到全因死亡（率比[RR]=1.41）、所有癌症（RR=1.64）、肝癌（RR=3.04）和心脏病（RR=2.22）的风险显著增加。抗-HTLV-I血清阳性与所有非肿瘤性疾病死亡率的相关性（RR= 1.40）和CHR ...更多信息 慢性肝病（RR=5.03）处于临界状态。本研究中不能排除输血和丙型/B型肝炎（HCV/HBV）病毒感染的可能混淆。但即使排除肝癌和慢性肝病，HTLV-Ⅰ携带者的死亡率仍明显升高（RR=1.32，95% CI 0.99-1.78），尤其是抗体滴度高者（RR=1.56，95% CI 0.99-2.46，P =0.04）。这些发现可能支持HTLV-I感染对成人T细胞白血病/淋巴瘤以外原因的死亡率产生不良影响的观点。可能需要进一步研究HCV/HBV感染的混杂因素以及HCV/HBV和HTLV-I之间的相互作用，以分析肝癌和慢性肝病的死亡率增加。(2)日本西南部成人T细胞白血病/淋巴瘤发病率及其对非霍奇金淋巴瘤发病率的影响的评估在日本西南部人类T细胞嗜淋巴细胞病毒I型（HTLV-I）流行区长崎，评估了成人T细胞白血病/淋巴瘤（ATL）的发病率及其对总非霍奇金淋巴瘤（NHL）发病率的影响。第一个研究区包括位于K群岛的四个城镇，1990年人口为26，870人。根据对18，485名受试者的血清学调查估计的总体HTLV-I血清阳性率为16.2%。通过使用长崎县癌症登记处（NPCR）的数据，并回顾临床和实验室信息，作者确定了1985-1995年诊断的40例ATL和35例其他NHL。在100，000名30岁或30岁以上HTLV-I携带者中，ATL的粗年发病率估计为男性137.7，女性57.4，调整年龄后存在显著的性别差异（率比=2.50，95%置信区间1.32-4.73）。30至79岁的累积风险估计约为男性6.6%，女性2.1%。在整个人群中，ATL占NHL总发病率的51-59%，显示HTLV-I感染的强烈影响。第二个研究区域包括整个长崎县（1990年总人口= 156万）。1985年至1995年期间，NPCR登记了989例ATL和1，745例其他NHL。ATL的世界年龄标准化年发病率估计为每100，000名30岁或以上的男性为10.5，女性为6.0，约占NHL总发病率的37-41%。少

There have been few longitudinal studies on the long-term health effects of human T-lymphotropic virus type-I (HTLV-I) infection. The authors performed a cohort study of HTLV-I infection and cause-specific mortality in 3,090 atomic-bomb survivors in Nagasaki, Japan, who were followed from 1985-1987 to 1995. The prevalence of HTLV-I seropositivity in men and women was 99/1,196 (8.3%) and 171/1,894 (9.0%), respectively. During a median follow-up of 8.9 years, 448 deaths occurred. There was one nonfatal case of adult T-cell leukemia/lymphoma (incidence rate=0.46 cases/ 1,000 person-years; 95% confidence interval [CI] 0.01-2.6). After adjustment for sex, age and other potential confounders, significantly increased risk among HTLV-I carriers was observed for deaths from all causes (rate ratio [RR]=1.41), all cancers (RR=1.64), liver cancer (RR=3.04), and heart diseases (RR=2.22). The association of anti-HTLV-I seropositivity with mortality from all non-neoplastic diseases (RR= 1.40) and chr … More onic liver diseases (RR=5.03 ) was of borderline significance. Possible confounding by blood transfusions and hepatitis C/B (HCV/HBV) viral infections could not be precluded in this study. However, even after liver cancer and chronic liver diseases were excluded, mortality rate was still increased among HTLV-I carriers (RR=1.32, 95% CI 0.99-1.78), especially among those with high antibody titers (RR=1.56, 95% CI 0.99-2.46, P for trend=0.04). These findings may support the idea that HTLV-I infection exerts adverse effects on mortality from causes other than adult T-cell leukemia/lymphoma. Further studies on confounding by HCV/HBV infections and the interaction between HCV/HBV and HTLV-I may be required to analyze the increased mortality from liver cancer and chronic liver diseases.(2) Evaluation of adult T-cell Leukemia/lymphoma incidence and its impact on non-Hodgkin's lymphoma incidence in southwestern JapanThe incidence of adult T-cell leukemia/lymphoma (ATL) and its impact on that of total non-Hodgkin lymphoma (NHL) were evaluated in Nagasaki, a human T-cell lymphotropic virus type-I (HTLV-I) endemic area in southwestern Japan. The first study area consisted of four towns located on the K-Islands, which had a population of 26,870 in 1990. The overall HTLV-I seroprevalence estimated from the serologic survey of 18,485 subjects was 16.2%. By using the data from the Nagasaki Prefectural Cancer Registry (NPCR) and reviewing clinical and laboratory information, the authors identified 40 cases of ATL and 35 cases of other NHL diagnosed during 1985-1995. The crude annual incidence of ATL among 100,000 HTLV-I carriers aged 30 or older was estimated at 137.7 for men and 57.4 for women, with a significant sex difference after adjustment for age (rate ratio=2.50, 95% confidence interval 1.32-4.73 ). The cumulative risk from 30 to 79 years of age was estimated at approximately 6.6% for men and 2.1% for women. Among the entire population, ATL accounted for 51-59% of the total NHL incidence, showing the strong impact of HTLV-I infection. The second study area consisted of the whole of Nagasaki Prefecture (total population in 1990=1.56 million). Between 1985 and 1995, 989 cases of ATL and 1,745 cases of other NHL were registered in the NPCR. The world age-standardized annual incidence rate of ATL per 100,000 persons aged 30 or older was estimated at 10.5 for men and 6.0 for women, which accounted for approximately 37-41% of the total NHL incidence. Less