202例散发性成人急性乙型肝炎患者的流行病学特征和血清学变化

郑冬春; 聂苑霞; 梁海林; 胡岳林; 成效; 冯晓霞; 陈永平

doi:10.3969/j.issn.1001-5256.2014.01.009

202例散发性成人急性乙型肝炎患者的流行病学特征和血清学变化

DOI: 10.3969/j.issn.1001-5256.2014.01.009

上海市黄浦区传染病医院临床科

基金项目:

上海市黄浦区卫生事业发展奖励基金(2009HGG-26)；

详细信息

中图分类号: R512.62
计量
- 文章访问数: 2647
- HTML全文浏览量: 21
- PDF下载量: 680
- 被引次数: 0
出版历程
- 收稿日期: 2013-06-25
- 出版日期: 2014-01-20

Epidemiological features and serological changes in sporadic acute hepatitis B among adults: an analysis of 202 cases

Shanghai Hospital for Infectious Diseases in Huangpu District

Research funding:

摘要

摘要: 目的了解散发成人急性乙型肝炎（AHB）流行病学特征及其血清病毒标志物（HBV M）演变规律。方法以202例成人AHB患者为研究对象,收集患者流行病学资料并定期随访检测ALT、TBil、HBV DNA、HBV M及其定量,观察其动态变化,随访期为48周。计数资料采用非参数秩和检验,计量资料组间比较采用成组t检验,相关性分析采用Person检验。结果 AHB患者男性明显多于女性,平均（42.99±7.31）岁。微量血传播方式最多,占29.20%,异性性传播占17.33%,但高达48.02%的患者传播途径不明。就诊时仅49.01%的患者HBV DNA阳性。HBV DNA阳性组血清ALT平均值为（1973.2±445.3）U/L;阴性组为（1500.3±287.7）U/L,两者差异无统计学意义（t=1.852,P>0.05）;HBV DNA阳性组血清TBil平均值为（118.40±37.33）μmol/L;阴性组为（81.06±23.24）μmol/L,两者差异有统计学意义（t=2.765,P<0.01）。初诊时HBV M呈现8种模式,以HBsAg、HBeAg、抗-HBc、抗-HB...
- 肝炎,乙型 /
- 流行病学 /
- 血清学
Abstract: Objective To investigate the epidemiological features and serological changes in sporadic acute hepatitis B ( AHB) among adults. Methods A total of 202 adult patients with AHB were selected as subjects. The epidemiological data of patients were collected, and follow- up was regularly performed for 48 weeks to monitor alanine aminotransferase ( ALT) , total bilirubin ( TBil) , hepatitis B virus ( HBV) DNA, and serological markers of HBV ( HBV- Ms) . Categorical data were analyzed by nonparametric rank sum test; comparison of continuous data between groups was made by independent- samples t test; correlation analysis was performed by Pearson test. Results Among AHB patients, there were more males than females; the mean age was 42. 99 ± 7. 31 years. Of all cases, 29. 20% developed the disease by micro blood transmission, 17. 33% by heterosexual transmission, and 48. 02% by unknown route of transmission. Only 49. 01% of the patients were positive for HBV DNA when visiting the hospital. The HBV DNA- positive group had a serum ALT level of 1973. 2 ± 445. 3 U / L, and the HBV DNA- negative group had a serum ALT level of 1500. 3 ± 287. 7 U / L, without significant difference between the two groups ( t = 1. 852, P > 0. 05) . The HBV DNA- positive group had a serum TBil level of 118. 40 ± 37. 33 μmol / L, and the HBV DNA- negative group had a serum TBil level of 81. 06 ± 23. 24 μmol / L, with significant difference between the two groups ( t = 2. 765, P < 0. 01) . Eight patterns of HBV- Ms were found in the patients who first visited the hospital; in the most frequent pattern, which was seen in 39. 11% of patients, HBsAg, HBeAg, anti- HBc, and anti- HBc IgM were detected, and in the second most frequent pattern, which was seen in 29. 27% of patients, HBsAg, anti- HBe, anti- HBc, and anti- HBc IgM were detected. The monitoring of HBV- Ms in 99 AHB patients who had complete data showed that the negative conversion rate of HBsAg was 97. 98%, and the average negative conversion time was 2. 5 weeks; the cumulative positive conversion rate of anti- HBs was 83. 84%; the negative conversion rate of HBeAg among HBeAg-positive patients was 100%, and all showed negative conversion within 4 weeks of onset; the positive conversion rate of anti- HBe was 80. 81%in the 48- week follow- up; serum anti- HBc remained detectable. In the acute phase, the 202 patients had HBsAg levels below 200 ng / ml, and the HBsAg level was inversely proportional to the negative conversion time of HBsAg. Conclusion Micro blood transmission and sexual transmission have become the main routes of transmission for sporadic AHB among adults. Rapid HBV DNA clearance and rapid seroconversion of HBsAg and HBeAg are the characteristics of sporadic AHB among adults. The HBsAg level in acute phase is helpful for determining the outcome of AHB. In this study, 2 cases were finally converted into chronic HBV infection.
- hepatitis B /
- epidemiology /
- serology

HTML全文

参考文献(14)

[1]HU XL, ZHAO HW, WU XY.The epidemic status of hepatitis B virus infection.[J].J Clin Hepatol, 2012, 28 (6) :413-416. (in Chinese) 胡晓丽, 赵宏伟, 吴晓岩.乙型肝炎病毒感染的流行现状[J].临床肝胆病杂志, 2012, 28 (6) :413-416.

[2]WANG XJ, ZHANG RZ, HU YS, et al.Study on the epidemic status of viral hepatitis in China[J].Dis Surveill, 2004, 19 (8) :290-293. (in Chinese) 王晓军, 张荣珍, 胡苑笙, 等.我国病毒性肝炎流行现状研究[J].疾病监测, 2004, 19 (8) :290-293.

[3]DING WJ.Analysis of epidemic situation in Shanghai city of Pudong New Area from 2001 to 2004, acute viral hepatitis[J].Sh J Prev Med, 2005, 17 (10) :473-474. (in Chinese) 丁王静.上海市浦东新区2001-2004年急性病毒性肝炎疫情分析[J].上海预防医学, 2005, 17 (10) :473-474.

[4]Chinese Society of Infection Diseases and Parasitology, Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Infect Dis, 2001, 19 (1) :54-62. (in Chinese) 中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) :54-62.

[5]HOU MC, WC JC, KUO BI, et al.Heterosexual transmission as the most common route of acute hepatitis B virus infection among adults in Taiwan the importance of extending vaccination to susceptible adults[J].J Infect Dis, 1993, 167 (4) :938-941.

[6]LIANG XS, WANG MB, LI CZ, et al.A high viral load are high risk factors of acute hepatitis B delayed recovery[J].Chin J Infect Dis, 2010, 28 (4) :222-225. (in Chinese) 梁雪松, 万谟彬, 李成忠, 等.高病毒载量是急性乙型肝炎恢复趋势延缓的高危因素[J].中华传染病杂志, 2010, 28 (4) :222-225.

[7]XIA GL.Hepatitis B vaccine prevention effect and genotypes of hepatitis B virus research[J].Chin J Epidemiol, 2002, 23 (3) :225-227. (in Chinese) 夏国良.乙型肝炎疫苗预防效果和乙型肝炎病毒基因分型研究[J].中华流行病学杂志, 2002, 23 (3) :225-227.

[8]XIE ZW.The changes of HBeAg level in hepatitis B antiviral treatment efficacy on[J].J Clin Hepatol, 2013, 29 (2) :150-152. (in Chinese) 谢志伟.乙型肝炎抗病毒治疗中HBeAg水平变化对疗效的影响[J].临床肝胆病杂志, 2013, 29 (2) :150-152.

[9]LI DL, MIU XH, MIAO QL, et al.Sporadic adult acute hepatitis B pathogen follow-up study[J].Chin J Infect Dis, 2009, 27 (9) :522-526. (in Chinese) 李东良, 缪晓辉, 苗千里, 等.散发性成人急性乙型肝炎病原学随访研究[J].中华传染病杂志, 2009, 27 (9) :522-526.

[10]SEEGER C, MASON WS.Hepatitis B virus biology[J].Microbiol Mol Biol Rev, 2000, 64 (1) :51-68.

[11]ZHU JH, WU XM.Clinical significance of hepatitis B serum HBV in patients with cccDNA[J].J Prac Med, 2013, 29 (3) :395-397. (in Chinese) 朱锦宏, 吴晓蔓.乙肝患者血清HBV cccDNA的临床意义[J].实用医学杂志, 2013, 29 (3) :395-397.

[12]LAPOSTOLLE BW, BOWDEN S, LOCARNINI S, et al.Persistence of cccDNA during the natural history of chronic hepatitis B and decline during adefovir dipivoxil therapy[J].Gastroenterology, 2004, 126 (7) :1750-1758.

[13]YANG Y, YANG L.Study on the correlation between detection and replication of hepatitis B virus serum HBsAg quantification[J].J Prac Med, 2013, 29 (5) :686-687. (in Chinese) 杨阳, 杨龙.血清HBsAg定量检测与乙型肝炎病毒复制的相关性研究进展[J].实用医学杂志, 2013, 29 (5) :686-687.

[14] Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline for prevention and treatment of chronic hepatitis B[J].J Clin Hepatol, 2006, 22 (1) :3-15. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南[J].临床肝胆病杂志, 2006, 22 (1) :3-15.

施引文献

资源附件(0)

访问统计