江苏省2012-2014年慢性HBV感染者HBeAg血清学转换后再逆转的特征分析  

Epidemiological characteristics of HBeAg reversion in chronic hepatitis B patients with HBeAg seroconversion in Jiangsu province, 2012-2014

作　　者：朱立国[1] 田华[2] 姜洁[1] 宋词[3] 邹艳[5] 徐建芳[6] 刘红建[7] 彭红[1] 胡志斌[4] 朱凤才[1] 沈洪兵[3] 翟祥军[1] 

机构地区：[1]江苏省疾病预防控制中心重大专项执行办公室,南京210009 [2]江苏省疾病预防控制中心急性传染病防制所,南京210009 [3]南京医科大学公共卫生学院,210029 [4]南京医科大学医药实验动物中心,210029 [5]张家港市疾病预防控制中心防疫科,215600 [6]丹阳市疾病预防控制中心防疫科,212310 [7]泰兴市疾病预防控制中心重大专项执行办公室,225400

出　　处：《中华流行病学杂志》2017年第1期43-48,共6页Chinese Journal of Epidemiology

基　　金：国家科技重大专项（2009ZX10004-904,2011ZX10004-902,2013ZX10004-905）;国家自然科学基金（81502861）

摘　　要：目的 了解慢性HBV感染者HBeAg血清学转换后发生HBeAg逆转的流行病学特征，为推进慢性HBV感染者的规范管理提供依据。方法 2012-2014年对在江苏省传染病防治示范区建立的已发生HBeAg血清学转换的慢性HBV感染者队列开展定期随访。通过Cox回归分析慢性HBV感染者HBeAg血清学转换后HBeAg逆转的特征及影响因素，通过重复测量数据方差分析方法分析不同HBeAg转归者HBV DNA的变化趋势。结果 2012年5 068例已发生HBeAg血清学转换的慢性HBV感染者［平均年龄（51.9±12.8）岁］随访至2014年时121例发生HBeAg逆转，观察9 359人年，HBeAg逆转率为1.3/100人年。HBeAg逆转率随年龄增长逐渐降低，从〈20岁年龄组的4.7/100人年下降至≥60岁年龄组的1.0/100人年。HBV DNA〈2 000 IU/ml的感染者HBeAg逆转率为1.1/100人年，低于≥200 000 IU/ml者（3.8/100人年）。通过Cox多元回归分析，相对于HBV DNA〈2 000 IU/ml者，HBV DNA≥200 000 IU/ml的感染者HBeAg逆转可能性增大（HR=3.44，95% CI：1.91-6.20，P=0.000）。HBeAg逆转组的HBV DNA和ALT较HBeAg持续阴性组均上升更快（P=0.000）。结论 社区人群中已发生HBeAg血清学转换的慢性HBV感染者有一定比例会发生HBeAg逆转，低年龄段和高病毒载量者的HBeAg逆转率高。对已发生HBeAg血清学转换的慢性HBV感染者应定期随访管理。Objective To understand characteristics and influencing factors of reversion of HBeAg in chronic hepatitis B patients with HBeAg sero-conversion, and provide epidemiological evidence for the regular management of chronic hepatitis B patients. Methods From 2012 to 2014, a cohort study was conducted among the chronic hepatitis B patients with sero-conversion of HBeAg in Jiangsu province. Association between participants＇ demographics, ALT, HBV DNA and incidence of HBeAg reversion was analyzed by Cox regression model. HBV DNA changing trend between patients with HBeAg reversion and patients with persistent HBeAg sero-conversion was compared by repeated measure data variance analysis. Results In 2012, there were 5 068 HBeAg seroconverted chronic hepatitis B patients aged （51.9±12.8） years enrolled. By 2014, HBeAg had reversed in 121 cases with the rate of 1.3/100 person-years. The probability of HBeAg reversion decreased with the age of the patients. By Cox regression analysis, HBV DNA level was an important influencing factor for the progress of HBeAg reversion. The patients with HBV DNA ≥200 000 IU/ml had a higher HBeAg reversion rate DNA （3.8/100 person-years） than those with HBV DNA〈2 000 IU/ml （1.1 person-years） （HR=3.44, 95%CI：1.91-6.20, P=0.000）. Compared with the persistent HBeAg sero-conversion group, HBV DNA and ALT showed a more dramatic increase in the HBeAg reversion group （P=0.000）. Conclusions There was a certain HBeAg reversion rate in chronic hepatitis B patients with HBeAg sero-conversion. Younger chronic CHB patients with HBeAg sero-conversion and those with higher HBV DNA lever had higher HBeAg reversion rate. Following up and management of chronic CHB patients with HBeAg sero-conversion is important and helpful for the control of hepatitis B.

关 键 词：肝炎病毒 乙型 乙型肝炎E抗原 逆转 队列 

分 类 号：R512.62[医药卫生—内科学]