农村乙型肝炎家庭中学龄前儿童乙型肝炎病毒血清学感染模式研究  

Serologic patterns of hepatitis B virus infections among rural preschool children after implementing the hepatitis B mother-to-child transmission program in Yichang city,Hubei province of China

作　　者：徐英[1] 张培[1] 刘建华[1] 鲁芳芳[1] 田滔滔[1] 吴周志[1] 段强 李山鹰 杨小英 XU Ying;ZHANG Pei;LIU Jian-hua;LU Fang-fang;TIAN Tao-tao;WU Zhou-zhi;DUAN Qiang;LI Shan-ying;YANG Xiao-ying(Center for Disease Control and Prevention of Yichang City,Yichang ,Hubei 443005)

机构地区：[1]宜昌市疾病预防控制中心,湖北宜昌443005 [2]宜昌市宜都市疾病预防控制中心,湖北宜昌443311 [3]宜昌市夷陵区疾病预防控制中心,湖北宜昌443100 [4]宜昌市枝江市疾病预防控制中心,湖北宜昌443200

出　　处：《中国病毒病杂志》2019年第1期12-17,共6页Chinese Journal of Viral Diseases

基　　金：湖北省自然科学基金项目(2013CFC128)

摘　　要：目的了解宜昌实施"预防艾滋病、梅毒和乙肝母婴传播工作实施方案"项目后,农村学龄前儿童乙型肝炎(乙肝)病毒(HBV)感染现状,以明确HBV感染的模式,降低母婴传播率。方法基于预防接种信息平台,按"分散选点,整群抽样"的原则,随机抽取3个县市,每县市3个乡镇的乙肝家庭学龄前儿童399名为实验组,对照组按1∶2匹配正常家庭同年龄同性别学龄前儿童758名;采集全血标本3ml,分离血清送检。流行趋势分析采用Pearson卡方检验,HBV感染阳性率比较用配对卡方检验,检验水准为0.05。结果共调查1 157名学龄前儿童,HBV感染率为1.12%(13/1 157),其中HBsAg阳性率为0.78%。HBsAg阳性率有随年份推移而呈现逐年下降的趋势,二者呈现负相关,相关性检验分析r=-0.948 (P<0.05)。实验组抗-HBs阳性率为70.93%(283/399);对照组抗-HBs阳性率为62.27%(472/758),实验组阳性率高于对照组,二者差异有统计学意义(χ2=6.03,P<0.05)。学龄前儿童HBV血清标志物模式以单项HBsAb阳性表达模式为主(65.25%),其余模式所占比例较低。正常家庭学龄前儿童HBV感染模式单一,但乙肝家庭学龄前儿童HBV感染模式呈现多样化特征,调查结果显示有6种感染模式(HBsAg·HBsAb;HBcAb;HBsAg·HBcAb;HBsAb·HBcAb;HBsAg·HBeAb·HBcAb;HBsAg),少数儿童的感染模式提示有较强的传染性。结论宜昌市全面实施乙肝母婴阻断项目,落实孕产妇乙肝筛查,对筛检出乙肝感染者的新生儿针对性开展乙肝联合免疫措施,及早干预使得高风险新生儿乙肝感染水平得以有效控制。但仍需加强农村乙肝家庭成员乙肝宣传与健康管理,降低家庭成员聚集性感染风险。Objective To understand the current status of hepatitis B virus(HBV)infections in rural preschool children after implementing the hepatitis B mother-to-child transmission program. Methods Based on the vaccination information platform and the principle of′Distributed Selection and Cluster Sampling′,three counties were randomly selected,and 399pre-school children of hepatitis B family in three towns were set as the experimental group;a total of 758 preschool children matched at 1∶2from non-hepatitis B family of the same age and gender were set as the control group.A total of 3ml of whole blood sample from each child was collected for serum separation.The Pearson chi-square test was used for epidemic trend analysis,and the HBV prevalence rate was tested by the matching chi-square test.The test level was 0.05,and P<0.05 was considered statistically significant. Results A total of 1 157 preschool children were studied.The HBV infection ratio was 1.12%(13/1 157)and the HBsAg positive rate was 0.78%.The positive rate of HBsAg decreased with the increase of the year showing a negative correlation(r=-0.948,P<0.05).The positive rate of antiHBs in the experimental group(283/399,70.93%)was higher than that in the control group(472/758,62.27%)(χ^2=6.03,P<0.05).Single HBsAb positive was the major pattern of HBV infection in preschool children(accounting for 65.25%)while the other six infection patterns(HBsAg·HBsAb;HBcAb;HBsAg·HBcAb;HBsAb·HBcAb;HBsAg·HBeAb·HBcAb;HBsAg)accounted for a lower proportion.HBV infection patterns among preschool children from non-hepatitis B families presented single pattern,while that from hepatitis B infection families showed diversified patterns. Conclusions Hepatitis B screening and mother-to-child transmission program should be fully implemented among pregnant women of Yichang city.The joint immunization measures of hepatitis B should be taken for newborn babies whose mothers are HBsAg positive.

关 键 词：乙型肝炎病毒(HBV) 学龄前儿童 感染模式 阳性率 聚集性感染 

分 类 号：R512.62[医药卫生—内科学]