江苏省2012-2014年HBeAg阳性慢性HBV感染者HBeAg阴转的特征分析  

A cohort study on the epidemiological characteristics of HBeAg sero-clearance in HBeAg positive chronic hepatitis B patients in Jiangsu province from 2012 to 2014

作　　者：朱立国[1] 姜洁[1] 宋词[2] 邹艳[3] 徐建芳[4] 刘红建[5] 彭红[1] 胡志斌[6] 朱凤才[1] 沈洪兵[2] 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]南京医科大学公共卫生学院,210029 [3]江苏省张家港市疾病预防控制中心防疫科,215600 [4]丹阳市疾病预防控制中心防疫科,212310 [5]泰兴市疾病预防控制中心重大专项执行办公室,225400 [6]南京医科大学医药实验动物中心,210029

出　　处：《中华流行病学杂志》2017年第2期179-184,共6页Chinese Journal of Epidemiology

基　　金：基金项目：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HBeAg阳性慢性HBV感染者发生HBeAg阴转的流行病学特征，为推进慢性HBV感染者的规范管理提供依据。方法 2012-2014年对江苏省传染病防治示范区HBeAg阳性慢性HBV感染者队列开展定期随访。通过Cox回归分析HBeAg阳性慢性HBV感染者HBeAg阴转特征及影响因素，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721例HBeAg阳性慢性HBV感染者（平均年龄45.2岁±14.2岁）随访到2014年时393例发生HBeAg阴转，观察1 058人年，HBeAg阴转率为37.2/100人年。有抗病毒治疗史的感染者HBeAg阴转率为32.4/100人年。年长者的HBeAg阴转率较高，从〈20岁年龄组的7.0/100人年上升到≥60岁年龄组的62.0/100人年。HBV DNA〈2 000 IU/ml的感染者HBeAg阴转率为75.8/100人年，高于≥200 000 IU/ml者的阴转率（16.1/100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阴转可能性降低（HR=0.18，95%CI：0.13~0.23，P〈0.001）。HBeAg阴转组的HBV DNA较HBeAg持续阳性组下降更快（P〈0.001）。结论 HBeAg阳性慢性HBV感染者HBeAg阴转率与年龄和HBV病毒载量有关，对不同特征的HBeAg阳性感染者应采取针对性的管理和干预措施。Objective To understand the epidemiological characteristics and influencing factors related to HBeAg sero-clearance in chronic hepatitis B patients so as to provide evidence for regular management on chronic HBV patients. Methods From 2012 to 2014, a cohort study was conducted among HBeAg positive chronic HBV patients in Jiangsu province. Association between the characteristics and incidence of HBeAg sero-clearance was analyzed by Cox regression method. The changing trend on HBV DNA between patients with HBeAg sero-clearance and those with persistent HBeAg positive status was compared by repeated measure data variance analysis method. Results In 2012, there were 721 HBeAg positive hepatitis B patients aged （45.2±14.2） years enrolled in this study. By 2014, the follow-up observation period was 1 058 person-years, and 393 cases had lost their HBeAg status, with the rate as 37.2/100 person-years. The HBeAg sero-clearance rate was 32.4/100 person-years in hepatitis B patients who received antiviral treatment. The probability of HBeAg clearance in HBeAg positive hepatitis B patients aged ≥60 year （62.0/100 person-years） was higher than those of aged 〈20 year （7.0/100 person-years）. The rate of HBeAg sero-clearance in HBeAg positive patients with HBV DNA 〈20 000 IU/ml （75.8/100 person-years） was higher than those whose HBV DNA were ≥200 000 IU/ml （16.1/100 person-years）. By Cox regression analysis, the HBV DNA level was an important influencing factor on the progress of HBeAg sero-clearance. Patients with HBV DNA levle as ≥200 000 IU/ml, had a lower HBeAg clearance rate （HR=0.18, 95%CI：0.13-0.23, P〈0.001）. Compared to the persistent HBeAg positive group, HBV DNA showed a more dramatic fall in the HBeAg-lost group （P〈0.001）. Conclusion The rate of HBeAg sero-clearance among HBeAg positive hepatitis B patients was correlated with age and HBV DNA status of the patients that called for comprehensive management and intervention programs to develop for the HBeAg positive hepatitis

关 键 词：肝炎病毒 乙型 乙肝E抗原 阴转 队列 

分 类 号：R512.62[医药卫生—内科学]