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

关于感染人类T淋巴细胞病毒I型(HTLV-I)对健康的长期影响的纵向研究很少。作者对日本长崎3090名原子弹幸存者进行了一项关于HTLV-I感染和特定原因死亡率的队列研究，这些幸存者在1985-1987年至1995年进行了跟踪调查。HTLV-I血清阳性率男性为99/1196(8.3%)，女性为171/1,894(9.0%)。在中位数8.9年的随访中，发生了448例死亡。有1例非致死性成人T细胞白血病/淋巴瘤(发病率=0.46例/1000人年；95%可信区间[CI]0.01-2.6)。在调整了性别、年龄和其他潜在混杂因素后，HTLV-I携带者死于所有原因(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(RR=1.4)和CHR…死亡率的关系更多的肝脏疾病(RR=5.03)具有边缘意义。在这项研究中，不能排除输血和丙型肝炎/乙肝(丙型肝炎/乙肝)病毒感染的可能。然而，即使排除了肝癌和慢性肝病，HTLV-I携带者的死亡率仍在上升(RR=1.32，95%CI 0.99~1.78)，尤其是高抗体滴度携带者(RR=1.56，95%CI 0.99~2.46，趋势P=0.04)。这些发现可能支持这样的观点，即HTLV-I感染对成人T细胞白血病/淋巴瘤以外的其他原因的死亡率产生不利影响。(2)评估日本西南部成人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评估日本西南部人类T细胞白血病/淋巴瘤(HTLV-I)流行区长崎成人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。第一个研究区由K群岛上的四个城镇组成，1990年人口为26870人。从18,485名受试者的血清学调查中估计的HTLV-I总体血清阳性率为16.2%。通过使用来自长崎县癌症登记处的数据，并回顾临床和实验室资料，作者确定了1985-1995年间诊断的40例ATL和35例其他NHL。在100,000名30岁或以上的HTLV-I携带者中，ATL的粗略年发病率估计为男性137.7例，女性57.4%，经年龄调整后，性别差异显著(比率比=2.5，95%可信区间1.32-4.73)。从30岁到79岁的累积风险估计男性约为6.6%，女性约为2.1%。在整个人群中，ATL占NHL总发病率的51%-59%，显示出HTLV-I感染的强烈影响。第二个研究区包括整个长崎县(1990年总人口=156万)。1985年至1995年，全国非霍奇金淋巴瘤研究所登记了989例ATL和1745例其他非霍奇金淋巴瘤。世界年龄标准化的30岁或30岁以上人群中急性淋巴细胞性白血病的年发病率估计为男性10.5例，女性6.0例，约占非霍奇金淋巴瘤总发病率的37-41%。较少

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