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队列建立 Cohort foundation

Qidong City, namely Qidong County before 1988, located in the north shore beside the estuary of Yangtze River, has a population of approximate 1.1 million. In 1970s, A population-based retrospective survey on cancer mortality revealed that mortality rate ascribed to hepatocellular carcinoma (HCC) in Qidong were 48.37/100,000, not only getting a leading position in the rank list of all cancer mortality, but exceeding all other adjacent areas along the Yangtze river such as Haimen and Shanghai. Subsequently, further whole-population incidence survey found that the HCC incidence rate in Qidong was 85.1/100,000 in male, and 23.3/100,000 in female respectively during 1983-1987, both of which were ranked leading position across mainland China.

Thus, habitually named “Qidong high incidence scene of liver cancer” had been accepted and known to outside since then. Several etiological factors had been suggested to explain the high endemicity of HCC in Qidong, which were chronic hepatitis B virus (HBV) infection, dietary aflatoxin contamination, selenium deficiency, familial transmissibility, and drinking water polluted by blue green algal toxins. Because the associations between HCC and its risk factors were almost all obtained from the cross-sectional studies, obviously, there was an urgent need of more convinced data with superior validity to explain such breathtaking HCC occurrence, and which consequently inspired an active motivation for establishing cohort studies in Qidong. Based on this reason, the “Qidong Hepatitis B Virus Infection Prospective Study, QHBVIPS” was initiated in 1991 by Qidong liver cancer institute, Shanghai cancer institute, and Johns Hopkins University.

We planned to allocate the participants whose serum Hepatitis B virus antigen(HBsAg) were positive into HBV infected sub-cohort and those who were HBsAg negative into HBV uninfected sub-cohort. In 20 MAY 1992, the enrollment phase of this cohort was completed and follow-up procedure launched as scheduled. The study protocol and the informed consent used for this study were approved by the ethical review committees of Qidong liver cancer institute(QDLCI), Shanghai cancer institute(SCI), and Johns Hopkins University(JHU).