江苏省非活动性HBsAg携带者代谢性疾病危险因素对乙型肝炎再活动影响的队列研究  

Association between metabolic risk factors and the hepatitis B reactivation of inactive HBsAg carriers in Jiangsu province: a cohort study

作　　者：徐建芳[1] 姜洁[2] 杨丽 钱姣 王涵 陈海明[5] 刘红建[6] 宋词[7] 徐昕 朱凤才[8] 朱立国[8] 翟祥军[2] Xu Jianfang;Jiang Jie;Yang Li;Qian Jiao;Wang Han;Chen Haiming;Liu Hongjian;Song Ci;Xu Xin;Zhu Fengcai;Zhu Liguo;Zhai XiangJun(Department of Acute Infectious Diseases Control and Immunization Programmes,Danyang County Center for Disease Control and Prevention,Danyang 212310,China;Major Project Executive Office,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,China;School of Public Health,Xiamen University,Xiamen 361102,China;School of Public Health,Nanjing Medical University,Nanjing 210029,China;Department of Infectious Disease Control,Zhangjiagang County Center for Disease Control and Prevention,Zhangjiagang 215600,China;Major Project Executive Office,Taixing County Center for Disease Control and Prevention,Taixing 225400,China;Collaborative Innovation Center For Cancer Personalized Medicine,Nanjing Medical University,Nanjing 210029,China;Key Laboratory of Intestinal Pathogenic Microbiology,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,China)

机构地区：[1]丹阳市疾病预防控制中心急传与免疫规划科,丹阳212310 [2]江苏省疾病预防控制中心重大项目办公室,南京210009 [3]厦门大学公共卫生学院,厦门361102 [4]南京医科大学公共卫生学院,南京210029 [5]张家港市疾病预防控制中心传染病防治科,张家港215600 [6]泰兴市疾病预防控制中心重大项目办公室,泰兴225400 [7]南京医科大学肿瘤个体化医学省部共建协同创新中心,南京210029 [8]江苏省疾病预防控制中心肠道病原微生物重点实验室,南京210009

出　　处：《中华流行病学杂志》2022年第8期1301-1308,共8页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10715-002);国家自然科学基金(81502861,81673244);江苏省青年医学人才(QNRC2016546);江苏省第五期“333工程”(BRA2018399);江苏省卫生健康委科研课题(H2018096,Y2018071)。

摘　　要：目的分析代谢性疾病危险因素等对非活动性HBsAg携带者(IHC)发生乙型肝炎(乙肝)再活动的流行病学特征,为规范慢性HBV感染者的管理提供科学依据。方法基于2010年建立的江苏省慢性HBV感染者队列,通过2012-2020年的6次随访,分析IHC发生乙肝再活动的流行病学特征以及超重、高血压、糖尿病、高血脂等代谢性疾病危险因素对乙肝再活动的影响。结果2527例IHC随访至2020年,共随访17730人年,平均随访时间为7.0人年,共发生乙肝再活动98例,累积发生率3.9%,发病密度为5.53/1000人年;多因素Cox比例风险回归分析结果显示,年龄、基线HBV DNA是IHC发生乙肝再活动的独立危险因素,与≥60岁年龄组相比,40~49岁组(aHR=2.16,95%CI:1.20~3.90)及20~29岁组(aHR=5.48,95%CI:2.07~14.48)发生乙肝再活动的风险显著升高;与基线时HBV DNA<100 IU/ml者相比,存在低病毒水平者(HBV DNA=100~1999 IU/ml)发生乙肝再活动的风险显著升高(aHR=1.67,95%CI:1.11~2.52);按照年龄分层分析结果显示,在≥50岁年龄组中,暴露于≥2个代谢性疾病危险因素者发生乙肝再活动的风险显著高于无代谢性疾病危险因素者(aHR=2.73,95%CI:1.08~6.96)。结论江苏省社区人群中IHC仍有发生乙肝再活动的风险,尤其是青壮年和低病毒活动水平的IHC;对于≥50岁且合并≥2个代谢性疾病危险因素的IHC,发生乙肝再活动的风险显著升高。对这部分人群应加强监测和管理,对于符合抗病毒治疗指征者应及时启动治疗,降低疾病进展的风险。Objective To analyze the impact of metabolic risk factors on the epidemiological characteristics of the reactivation of inactive HBsAg carriers(IHC)and provide effective intervention measures to standardize the management of chronic hepatitis B infections.Methods Based on the chronic hepatitis B infection cohort established in 2010 in Jiangsu province,six follow-up visits from 2012 to 2020 were conducted to analyze the characteristics and influencing factors of the hepatitis B reactivation of IHC and the impact of metabolic risk factors,including obesity,high blood pressure,diabetes and hyperglycemia.Results From 2012 to 2020,2527 IHC and 17730 person-years were observed during a median follow-up period of 7.0 person-years.Ninety-eight cases of hepatitis B reactivation,with a cumulative reaction rate,was 3.9%,and the incidence density was 5.53/1000 person-years.Multivariate Cox proportional risk regression analysis showed that age and baseline HBV DNA were independent risk factors of HBV reactivation.Compared with the patients≥60 years,40-49 age group(aHR=2.16,95%CI:1.20-3.90)and 20-29 age group(aHR=5.48,95%CI:2.07-14.48)were significantly associated with hepatitis B reactivation.Compared with the HBV DNA negative patients at baseline,the risk of hepatitis B reactivation was higher in the group with low HBV DNA level 100-1999 IU/ml(aHR=1.67,95%CI:1.11-2.52).Stratification analysis results showed that compared with those without metabolic risk factors,in the≥50 age group,patients with≥2 metabolic risk factors showed adjusted HR of 2.73(95%CI:1.08-6.96).Conclusions The risk of hepatitis B being reactive is the persistent existence of IHC in communities in Jiangsu province,especially young adults,low-level HBV DNA carriers,and IHC with≥2 metabolic risk factors.Follow-up for these IHC should be strengthened to reduce the risk of disease progression by antiviral treatment at the right time.

关 键 词：慢性乙型肝炎 代谢性疾病 队列研究 非活动性乙型肝炎表面抗原携带者 乙型肝炎再活动 

分 类 号：R181.3[医药卫生—流行病学] R512.62[医药卫生—公共卫生与预防医学]