广州市社区居民病毒性肝炎血清流行病学调查及相关影响因素分析  

Seroepidemiologic study of viral hepatitis and its risk factors among residents in Guanzhou City

作　　者：湛柳华[1] 黄丽娟[1] 周文[1] 郝元涛[2] 张宇峰[3] 肖晓玲[1] 戴丽萍[1] 

机构地区：[1]广州市越秀区疾病预防控制中心,广东广州510055 [2]中山大学公共卫生学院 [3]中山医科大学附属第三医院

出　　处：《华南预防医学》2012年第3期18-21,共4页South China Journal of Preventive Medicine

基　　金："十一五国家科技重大专项课题"基金资助项目(编号2009ZX10001-018)

摘　　要：目的了解社区居民病毒性肝炎的血清流行病学情况,分析乙型肝炎(乙肝)的危险因素,为进一步探索社区居民肝炎综合防治措施提供科学依据。方法以分层随机抽样方法,于2010年在广州市选取3个街道的社区居民为调查对象,采用面对面询问方式问卷调查,收集一般情况、生活史、家族史、乙肝知识、乙肝疫苗注射史等信息。采用ELISA法检测调查对象血样的HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc和抗-HAV IgG、抗-HCV IgG共7项指标。采用logistic回归分析方法分析影响乙肝感染率的因素。结果调查了2 015户家庭居民共3 511人,其中男性1 403人,女性2 108人。人群抗-HAV IgG、抗-HCV IgG、HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc阳性率分别为91.83%、0.74%、7.18%、61.75%、0.85%、12.90%和17.23%;HBsAg阳性率峰值出现在31～40岁年龄组(12.80%,43/337);乙肝疫苗计划免疫策略实施后出生人群HBsAg阳性率为0.30%(1/328),大幅低于政策实施前出生的人群(7.89%,251/3 183)(P<0.01);HBV感染率为16.80%(590/3 511)。多因素logistic回归分析结果表明,有肝炎家族史是HBV感染的危险因素(OR=33.52),而接种乙肝疫苗是保护因素(OR=0.56)。结论广州市社区居民甲肝免疫水平较高,通过持续的肝炎防治,乙肝和丙肝的感染率有所降低,乙肝疫苗免费接种有效降低了新生儿和青少年的乙肝感染率,但成年人这一指标仍处于较高水平,建议今后应针对性改进社区居民尤其乙肝患者家属这一高危人群肝炎综合防治措施。Objective To better understand the condition of viral hepatitis of residents, we conducted a seroepidemiological study in Guangzhou City, and analyzed its risk factors, so as to provide basis for taking comprehensive control measures to viral hepatitis. Methods Multistage random sampling was used to select subjects in Guangzhou City. Venous blood samples were collected for testing anti-HAV IgG, anti-HCV IgG, HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc. Questionnaire survey was conducted for collecting information such as life history, family, knowledge of viral hepatitis, and hapatitis vaccintion. The influence factors were analyzed by non-conditional logistic regression model. Results A total of 3 511 residents （ 1 403 male and 2 108 female） in 2 015 families were investigated. The prevalence rates of anti- HAV IgG, anti-HCV IgG, HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc were 91.83% , 0.74% , 7.18% ,61.75% , 0.85%, 12.90% , and 17.23% , respectively. The highest prevalence rate of HBsAg was 12.80% （43/337） in age group of 31 to 40 years old. The positive rate of HBsAg was 0.30% （ 1/328 ） among the population who were born after the expanded program on immunization （EPI） was conducted in 1992, but 7.89% （251/3 183） for the people born before 1992 （P 〈0. 01 ）. The infection rate of HBV was 16.80% （ 590/3 511 ）. The result of logistic regression indicated that histories of viral hepatitis infected family associated with HB viral infection was a risk factor in the model （ OR = 33.52 ）, while HBV vaccination was a protective factor （ OR = 0.56）. Conclusion There was a better condition of anti-HAV IgG of residents in Guangzhou. Results revealed that since the hepatitis B vaccine was introduced into the EPI from 1992, the prevalence rates of HBsAg and HBV infection, especially in the children had obviously declined. We should strengthen HBV immunization for adults for the control of hepatitis B infection.

关 键 词：肝炎 乙型 血清流行病学研究 危险因素 

分 类 号：R512.6[医药卫生—内科学]