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

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台灣的慢性肝炎、肝硬化及肝細胞癌的主因。另發現在台灣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%發生肝細胞痛。在台灣的研究證明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在台灣慢性肝炎，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。

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 hepatocellular 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-positivc 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 immunoprophylaxis, which was 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. I 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.