青岛市某医院患者丙型肝炎病毒感染情况及预测因素分析  

Analysis of hepatitis C virus infection and its predictors in a hospital in Qingdao city

作　　者：尤文铮 张旸[2] 李梅[3] 赵真真 辛永宁[1,2] 宣世英[1] You Wenzheng;Zhang Yang;Li Mei;Zhao Zhenzhen;Xin Yongning;Xuan Shiying(Qingdao Clinical Medical College Affiliated to Nanjing Medical University,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Infectious Diseases,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Laboratory Medicine,Qingdao Municipal Hospital,Qingdao 266011,China;Laboratory of Liver Diseases,Qingdao Municipal Hospital,Qingdao 266011,China)

机构地区：[1]南京医科大学附属青岛临床医学院青岛市市立医院,山东青岛266011 [2]青岛市市立医院感染性疾病科,山东青岛266011 [3]青岛市市立医院检验科,山东青岛266011 [4]青岛市市立医院肝病研究室,山东青岛266011

出　　处：《中国肝脏病杂志（电子版）》2022年第4期55-61,共7页Chinese Journal of Liver Diseases：Electronic Version

基　　金：国家自然科学基金(31770837)。

摘　　要：目的通过对青岛市某医院就诊人群丙型肝炎病毒抗体(hepatitis C virus antibody,抗-HCV)和丙型肝炎病毒核酸(HCV RNA)检测,评估丙型肝炎病毒(hepatitis C virus,HCV)感染情况及其预测因素。方法选取2019年1月1日至2019年12月31日在青岛市某医院行抗-HCV检测的患者共76492例,分析抗-HCV阳性率与性别和年龄的关系、抗-HCV阳性患者就诊科室分布及HCV RNA检测情况。共纳入172例行HCV RNA检测的抗-HCV阳性患者,分为HCV RNA阴性组和HCV RNA阳性组,收集两组患者ALT、AST、PLT、TBil、抗-HCV数据,计算谷草转氨酶与血小板比值(APRI)、纤维化指数-4(FIB-4),计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ^(2)检验,采用Spearman相关分析各变量与HCV RNA阳性的相关性,采用二元Logistic回归模型分析HCV RNA阳性的预测因素。采用受试者工作特征(ROC)曲线评估抗-HCV水平对HCV RNA阳性的诊断价值。结果青岛市某医院25.82%抗-HCV阳性住院患者进行了HCV RNA检测,抗-HCV总体阳性率约为0.96%。不同年龄组间抗-HCV阳性率差异有统计学意义(P<0.05)。85.68%抗-HCV阳性患者年龄超过40岁。HCV RNA阳性组患者的ALT、AST、TBil、APRI、FIB-4和抗-HCV水平明显高于HCV RNA阴性组,PLT显著低于HCV RNA阴性组(P均<0.05)。Spearman相关分析提示HCV RNA阳性与ALT、AST、APRI、FIB-4和抗-HCV水平呈正相关(r值分别为0.551、0.613、0.576、0.302和0.763,P均<0.001),与PLT呈负相关(r=-0.346,P<0.001)。二元Logistic回归模型显示抗-HCV水平每增加1,HCV RNA阳性风险就增加83.9%(OR=1.839,95%CI:1.440~2.350,P<0.001)。ROC曲线表明,血清抗-HCV水平最佳截断值为7.48(COI)时,诊断HCV RNA阳性的曲线下面积、灵敏度和特异度分别为0.956、98.4%和87%。结论应加强对40岁以上人群和高危科室患者的抗-HCV筛查,推广对抗-HCV阳性患者的HCV RNA检测。抗-HCV水平可较准确预测HCV感染。Objective To evaluate the situation of hepatitis C virus(HCV)infection and the predictive factors through the detection of hepatitis C virus antibody(anti-HCV)and HCV RNA in a hospital in Qingdao.Methods A total of 76492 patients were detected for anti-HCV from January 1,2019 to December 31,2019 in a hospital in Qingdao city.The relationships between anti-HCV positive rate and gender and age were analyzed,as well as the departments distribution of anti-HCV positive patients and HCV RNA detection.A total of 172 anti-HCV positive patients were divided into HCV RNA negative group and HCV RNA positive group.ALT,AST,PLT,TBil,and anti-HCV levels of two groups were collected,and the aspartate aminotransferase to platelet ratio index(Apri)and fibrosis-4(FIB-4)were calculated.The Mann-Whitney U test was used for continuous data comparison between two groups,and chi-square test was used for categorical data comparison between two groups.Spearman test was applied to analyze the correlation between variables and HCV RNA positive detection.And the binary Logistic regression model was applied to analyze the predictive factors for positive HCV RNA.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of anti-HCV level for positive HCV RNA.Results Among the patients in a hospital in Qingdao,25.82%of anti-HCV positive inpatients were tested for HCV RNA.The overall positive rate of anti-HCV among the patients in a hospital in Qingdao was about 0.96%.There was significant difference in the positive rate of anti-HCV between different age groups(P<0.05).About 85.68%of anti-HCV positive patients were over 40 years old.ALT,AST,TBil,APRI,FIB-4 and anti-HCV levels of HCV RNA positive group were significantly higher than those of HCV RNA negative group,and PLT was significantly lower than that of HCV RNA negative group(all P<0.05).Correlation analysis showed that positive HCV RNA was positively correlated with ALT,AST,APRI,FIB-4 and anti-HCV levels(r values were 0.551,0.613,0.576,0.302 and 0.763 respectivel

关 键 词：丙型病毒性肝炎 丙型肝炎病毒抗体 丙型肝炎病毒核酸 流行病学 

分 类 号：R512.63[医药卫生—内科学] R181.3[医药卫生—临床医学]