摘要
目的比较山东省戊肝高发区临床稳定期慢性乙肝(Chronic hepatitis B,CHB)患者和非乙肝健康人群戊肝病毒(Hepatitis E virus,HEV)新发感染率。方法 2016年8~10月,在山东省戊肝报告发病率最高的乳山市社区人群中招募≥30周岁,既往无戊肝病史和戊肝疫苗接种史的CHB患者和非CHB健康人群。对所有招募对象进行问卷调查和血标本采集,用酶联免疫吸附法(ELISA)检测乙肝病毒表面抗原(Hepatitis B surface antigen,HBsAg)、戊肝IgM抗体(IgM antibody against hepatitis E,抗-HEV IgM)和IgG抗体(IgG antibody against hepatitis E,抗-HEV IgG)。CHB患者进行肝脏B超和转氨酶检测。CHB招募对象符合以下条件者纳入CHB组:①既往二级以上医疗机构诊断为CHB;②检测HBsAg阳性,抗-HEV IgG、IgM均为阴性,谷丙转氨酶(ALT)小于1.5倍正常值上限;③B超检查无脾脏肿大和肝硬化、肝癌影像学表现。非CHB招募对象按照1∶1比例,性别相同,年龄相差小于3岁,将HBsAg、抗-HEV IgG、抗-HEV IgM均为阴性者纳入健康对照组。对两组研究对象于2016年11月进行随访,采集血标本,再次检测其抗-HEV IgM和抗-HEV IgG,计算戊肝新发感染率及其影响因素。结果共随访CHB组病例219例,随访期为15~80 d,共发现HEV新感染者4例,戊肝新发感染率为1.0/100人月(95%C1:0.02~1.98/100人月)。共随访健康人群234例,随访期为15~68 d,共发现HEV新感染者5例,戊肝新发感染率为1.32/100人月(95%C1:0.17~2.47/100人月)。CHB组和非CHB组新发感染率差异无统计学意义(Fisher精确概率法,P>0.05)。多因素分析显示,排除年龄、性别、随访时间,未发现CHB与HEV新发感染有关[OR=0.90(95%CI:0.24~3.44),P>0.05]。9例新发感染者谷丙转氨酶(ALT)检测正常,且均未出现戊肝感染临床症状。结论 CHB患者戊肝新发感染率可能与健康人群相似。
Objective To compare the rate of hepatitis E virus (HEV) new infections between chronic hepatitis B (CHB) patients and non-CHB population in HEV high prevalence rate in Shandon province. Methods The volunteers with and without chronic hepatitis B were recruited from August to October 2016 in Rushan city of Shandong province, which had the highest hepatitis E incidence in the province. All volunteers were above 30 years old and had no history of hepatitis E vaccination. Questionnaire and blood sample collection were conducted among them. The blood sample was detected for hepatitis B surface antigen ( HBsAg), IgM antibody against hepatitis E virus (anti-HEV IgM) and IgG antibody against hepatitis E virus (anti-HEV IgG) for all volunteers. The liver ultrasound examination and the detection of ALT and AST were further conducted for CHB volunteers. The volunteers were involved in CHB group in the study if they met the following criteria:①had been diagnosed as CHB patients in the hospitals at two or above level;②were positive for HBsAg and negative for anti-HEV IgM and IgG;③had ALT equal to or under 1. 5 times of upper limit of normal (ULN);④showed no splenomegaly and liver cancer through B ultrasound. The non-CHB group was selected randomly from the volunteers negative for HBsAg,anti-HEV IgM and anti-HEV IgG according to being 1:1 matched with age and sex. All participants were followed up in November 2016 and blood samples were collected for the detection of anti-HEV IgG and anti- HEV IgM. New HEV infection was defined as seroconversion of anti-HEV IgG or anti-HEV IgM. The rate of new HEV infections was compared between the 2 groups. Results A total of 219 participants were followed-up in CHB group with the follow-up period from 15-80 days. Totally 4 persons with new HEV infections were found and the rate was 1. 0/100 person- months (95% CI :0. 02/100 person-months, 1. 98/100 person- months).In non-CHB group, 234 persons were followed and the follow-up period was 15-68 days. Among them, 5 persons were found to newly infected by HEV and the rate of new infections was 1. 32/100 person-months (95% CI : 0. 17/100 person-months, 2. 47/100 person-months). No significant difference was found between the 2 groups ( Fishers exact test, P >0. 05). The multi-variable analysis showed that after adjusting for age,sex and follow-up period,CHB was no collected with HEV new infection [ OR =0. 80 (95% CI : 0. 24-3. 44);P >0. 05]. The ALT level was under ULN and no clinic signs suggested of HEV infection for all person with HEV new infections in both groups. Conclusion The risk for HEV new infections might be similar between CHB patients and healthy population.
作者
张丽
颜丙玉
刘甲野
吴文龙
吕静静
冯艺
徐爱强
ZHANG Li;YAN Bing-yu;LIU Jia-ye;WU Wen-long;LV Jing-jing;FENG Yi;XU Ai-qiang(Shandong Center for Disease Control and Prevention, Jinan,Shandong,250014,China)
出处
《预防医学论坛》
2019年第6期407-410,413,共5页
Preventive Medicine Tribune
基金
山东省医药卫生科技发展计划(2016WS0386)
山东省泰山学者工程(ts201511105)
山东省疾病预防控制中心、山东预防医学会、厦门万泰沧海生物技术有限公司合作项目(PRO-HE-009)
关键词
乙、戊型肝炎
慢性肝炎
新发感染
队列研究
Hepatitis B and E
Chronic hepatitis B
New infection
Cohort study
