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題名 | 在臺灣控制肝細胞癌及肝硬化盛行有關的研究與措施及其成效=The Control of Liver Cirrhosis and Hepatocellular Carcinoma in Taiwan: Studies, Policies and Their Efficacy |
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作者 | 宋瑞樓; Sung, Juei-low; |
期刊 | 臺灣醫學 |
出版日期 | 19970100 |
卷期 | 1:1 1997.01[民86.01] |
頁次 | 頁1-11 |
分類號 | 415.5332 |
語文 | chi |
關鍵詞 | 肝細胞癌; 肝硬化; B型肝炎病毒的感染與預防; Hepatocellular carcinoma; Cirrhosis; Hepatitis B virus infection and prevention; |
中文摘要 | 惡性腫瘤死亡例中肝癌佔首位, 1994 年男多於女 3.6 倍。原發性肝癌中肝細胞癌 佔臨床病例之 73.3 %,解剖病例的 89.2 %, 其中 85.1 % 併發肝硬化,肝硬化之 98.6 % 是壞死後型,暗示病毒感染或毒素之攝食是其起因。1953 年開始應用管針肝生檢,接著 SGPT ( ALT )之應用發現慢性肝炎,特別是無症狀的盛行,其中慢性活動性肝炎多發於 20-40 歲之男性。 自 1969 年開始發現 B 型肝炎病毒慢性感染是在臺灣的慢性肝炎、肝硬化及肝細胞癌的主因。 另發現在臺灣 B 型肝炎病毒感染盛行,其感染先於分娩週邊期來自 e 抗原陽性母親,接著 重要由打針感染,青春期前感染容易發生慢性感染,引起 B 型肝炎表面抗原( HBsAg )陽 性者於 39 歲以內群 18 多 %,70 歲群尚高至 7 %。 在這麼長久的感染中,兒童時期 e 抗原陽性率高,病毒量多,但是少發生肝炎, 20 歲左 右開始活動性的肝炎出現, 其中發生慢性活動性肝炎病例中約 37 % 發生肝硬化, 肝硬化之 8% 發生肝細胞癌。 在臺灣的研究證明 B 型肝炎球蛋白( HBIG )加 B 型肝炎疫苗,可有效的預防生產週邊期 來自 e 抗原陽性母親的感染後,政府決定對新生兒全面施行 B 型肝炎預防注射,自 1984 年 開始。其七年評估試驗之成果顯示可使 18 多 % 的帶原率降至 2.6 %,1990 年左右以後出 生的會降至 0.2 % 。 C 型肝炎病毒慢性感染被認定為臺灣慢性肝炎,肝硬化及肝細胞癌之第二種主因。雖然無 C 型肝炎疫苗,對 B 型肝炎水平感染宣導措施 (使用拋棄式醫療器或完全消毒等)之成效 ,加上捐血檢驗納入 C 型肝炎抗體檢驗,也會控制 C 型肝炎之感染,結果肝細胞癌及肝硬 化會自國敵名單上消失。 |
英文摘要 | Since the Australia antigen (hepatitis-associated antigen, hepatitis B surface antigen (HBsAg)) was first studied in liver disease in 1969, chronic hepatitis B virus (HBV) infection has been shown to be the main cause of chronic hepatitis, cirrhosis and hepatocelluar carcinoma (HCC) in Taiwan. More than 80% of patients with these three liver diseases are HBsAg-positive. In addition, it has been noted that Taiwan is a hyperendemic area of HBV infection and HBsAg-carrier state. HBV infections usually start during the perinatal period in 95% of neonates born to hepatitis B e antigen (HBeAg)-positive mothers, and 87% of them go on to develop chronic carrier state. Steadily increasing horizontal infection of HBV follows after birth. After hepatitis B immune globulin (HBIG) and hepatitis B vaccination for neonates born to HBeAg-positive mothers were found to be effective for control of HBV infection, with efficacy rates of 87% to 95%, the government decided to proceed with nationwide neonatal hepatitis B immunoprophylalaxis, which wa s started in 1984. A 7-year evaluation study conducted from 1984 to 1991 suggested that the HBsAg-positive rate will drop from the current level of 18% to 2.8% in those born in 1984-1989 and it may further drop to 0.2% in those born thereafter. It was demonstrated by another study that the HBsAg-positive rate dropped in those born in 1982-1983 only after the usage of disposable medical instruments or complete sterilization. Therefore, it is very likely that the incidence of HBV infection has decreased in Taiwan. Chronic hepatitis C virus (HCV) infection was demonstrated as the second major cause of chronic hepatitis, cirrhosis and HCC in Taiwan. After the inclusion of anti-HCV assay in blood screening started in July of 1992, the incidence of posttransfusion hepatitis decreased from 13% to 2.8%. Therefore, the incidence of chronic hepatitis, cirrhosis and HCC should decrease by around 95% in the future in Taiwan. The control of HBV infection as well as HBV-related liver problems through extensive continuing researches and the following policy making in Taiwan is a good model for demonstrating the important role of medical studies in promoting health of our people. |
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