农村社区非活动性HBsAg携带者HBV再激活发生率及特征分析  

Rates and characteristics for hepatitis B reactivation of inactive hepatitis B carriers in rural communities

作　　者：赵雪 吕静静[2] 颜丙玉[2] 冯艺[2] 窦璇 刘甲野 徐爱强 张丽[2] Zhao Xue;Lyu Jingjing;Yan Bingyu;Feng Yi;Dou Xuan;Liu Jiaye;Xu Aiqiang;Zhang Li(School of Public Health,Cheeloo College of Medicine,Shandong University,Ji'nan 250012,China;Department of Immunization Programme,Shandong Center for Disease Control and Prevention,Ji'nan 250014,China;The Third People's Hospital of Shenzhen,Shenzhen 518112,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院,济南250012 [2]山东省疾病预防控制中心免疫预防管理所,济南250014 [3]深圳市第三人民医院,518112

出　　处：《中华流行病学杂志》2021年第9期1553-1558,共6页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10721202);国家自然科学基金(81803299);山东省自然科学基金(ZR2019PH046);山东省医药卫生科技发展计划(2015WS0285)。

摘　　要：目的了解农村社区非活动性HBsAg携带者(IHC)中HBV再激活的发生强度和特征。方法分别于2018、2020年对济南市章丘区农村社区人群体检中发现的IHC进行随访调查,比较2次随访结果,分析基于社区人群的IHC的HBV再激活发生率和分布特征。结果424名IHC完成了2次随访,发现HBV再激活者47例,累积再激活发生率为11.08%,发病密度为5.46/100人年;多因素分析显示,性别、年龄、吸烟、饮酒及肝病家族史和慢性病史与HBV再激活不相关(P>0.05),基线HBV DNA载量与再激活相关(P<0.05),当HBV DNA基线水平≥1000 IU/ml时,累积再激活发生率可达18.92%。发生再激活后,ALT平均水平较基线升高且异常率增加,再激活者肝功能趋于异常。4例(8.51%)再激活者发生肝炎,其中1例(2.13%)为黄疸型肝炎。结论济南市农村社区IHC中HBV再激活发生率较高;大部分再激活者处于无症状或轻度再激活状态;应加强对IHC的随访并密切监测其ALT和HBV DNA水平变化,并适时采取正规的治疗措施。Objective To analyze the intensity and epidemiological characteristics of hepatitis B virus(HBV)reactivation among inactive HBsAg carriers(IHC)of rural areas in Ji'nan.Methods In 2018 and 2020,follow-up investigations were conducted on IHC identified in the population physical examination in Zhangqiu district of Ji'nan.The results of the two follow-up visits were compared to analyze the incidence and distribution characteristics of HBV reactivation in IHC at the community level.Results A total of 424 IHC completed two follow-up visits,and 47 cases of HBV reactivation were found,the cumulative reactivation rate was 11.08%,and the incidence density was 5.46/100 person-years.Multivariate analysis showed that gender,age,smoking,drinking,family history of liver disease and chronic diseases were not associated with HBV reactivation(P>0.05),and baseline HBV DNA load was associated with reactivation(P<0.05),in the HBV DNA level≥1000 IU/ml group,the reactivation rate could reach 18.92%.After reactivation,the mean level of ALT increased from baseline and the abnormal rate increased,liver function tended to be abnormal in reactivated patients.4(8.51%)reactivators had hepatitis,and 1(2.13%)had jaundice hepatitis.Conclusions The incidence of HBV reactivation was higher among IHC in rural communities in Ji'nan.Most of the reactivators were asymptomatic or mildly reactivated.Follow-up of inactive HBsAg patients should be strengthened and changes in ALT and HBV DNA levels should be closely monitored.

关 键 词：慢性乙型肝炎 乙型肝炎表面抗原 非活动性乙型肝炎表面抗原携带者 乙型肝炎病毒再激活 

分 类 号：R512.62[医药卫生—内科学]