上海市1997－2012年戊型肝炎流行特征和基因分型研究  

Epidemiologic and genetic characteristics of hepatitis E virus in Shanghai, 1997-2012

作　　者：任宏[1] 李燕婷[1] 周欣[1] 王晔[1] 郑英杰[2] 朱奕奕[1] 陆一涵[2] 

机构地区：[1]上海市疾病预防控制中心急性传染病防治科,200336 [2]复旦大学公共卫生学院教育部公共卫生安全重点实验室

出　　处：《中华流行病学杂志》2013年第5期419-423,共5页Chinese Journal of Epidemiology

基　　金：国家自然科学基金（81001264）;上海市卫生局局级课题（2010-177）

摘　　要：目的系统分析1997--2012年上海市戊型肝炎（戊肝）的流行特征、血清学和基因分型特点。方法利用国家法定传染病报告数据；采用ELISA检测社区健康人群戊肝病毒（HEV）一IgG抗体，计算标化阳性率；使用巢式RT-PCR、基因测序和GenBank数据构建上海市HEV基因数据库。结果16年间上海市戊肝以散发为主，发病率呈季节性和周期性，总体略呈下降趋势。男性发病率显著高于女性，患者以30～65岁年中老年人为主。2001--2012年4次社区健康人群抗体水平监测，共采集血清标本3979份，人群HEV-IgG抗体标化阳性率分别为22．32％、18．56％、10．22％和34．43％，抗体阳性率与监测对象的年龄组别和地区分布呈显著关联。对2004--2008年上海市新发现的73株HEV同源性和进化树分析显示，HEV以基因Ⅳ型为主，包含4个已知基因亚型（4a、4d、4h和4i）；人病毒株序列与猪基因Ⅳ型病毒株序列（GU188851、DQ450072和EF570133）的核苷酸同源性分别为83．09％～97．96％、85．87％～97．26％和83．80％～95．10％；不同区县来源的HEV分离株中，同源性〉99％的序列有59对。结论戊肝仍是上海市需长期重点防治的急性传染病之一。其人畜共患命题还有待进一步探索。Objective The aim of this study was to systemically analyze the epidemiologic, serological and genetic characteristics of hepatitis E virus （HEV） in Shanghai from 1997 to 2012. Methods We analyzed the data related to the epidemics of hepatitis E from China Information System for Disease Control and Prevention. We implemented serological surveillance program, based on community healthy population with enzyme-linked immunosorbent assay method and estimated the standardized sero-prevalence. We also obtained nucleotide sequences of hepatitis E patients using the nested RT-PCT assays, together with propotype sequences in the GenBank to construct a HEV genetic database in Shanghai. Results In this paper, we found that the distribution of hepatitis E patients was sporadic in the past 16 years in Shanghai. The morbidity kept declining, but with seasonal and periodical fluctuation. Morbidity in males was significantly higher than in females, with the hard hit population between 30 and 65 year-olds. In total, 3979 sera samples were collected through the serological surveillance programs in 2001,2004, 2007 and 2012. The standardized sero-prevalence rates of the said years were 22.32%, 18.56%, 10.22% and 34.43% which all showing strong relationship with age groups and the regions where the populations were being monitored. 73 nucleotide sequences of hepatitis E patients from hospitals were identified, during 2004 and 2008. Results from phylogenetic analysis revealed that all HEV isolates belonged to genotype 1V and including 4 known subtypes 4a,4d, 4h and 4i which sharing 83.09%-97.96% , 85.87%-97.26% and 83.80%-95.10% nucleotide sequence identities with the swine HEV genotype IV of GU188851, DQ450072 and EF570133. Meanwhile, 59 HEV isolates from different districts shared 99% nucleotide sequence identities with each other. Conclusion Hepatitis E would still be a challenge for long time and the zoonotic questions that related to hepatitis E, need to be explored and explained in the future.

关 键 词：戊型肝炎 戊型肝炎病毒 流行特征 基因型 

分 类 号：R181[医药卫生—流行病学] R51[医药卫生—公共卫生与预防医学]