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摘要:
目的了解2018年浙江省健康人群乙型肝炎(乙肝)病毒血清标志物流行情况。 方法按照多阶段整群随机抽样的方法,抽取浙江省11个市及义乌市常住人口(居住6个月及以上)家庭中0~59岁人群进行问卷调查,并采集静脉血2 ml进行乙肝相关抗原抗体检测。 结果共调查4 194人,乙肝表面抗原(HBsAg)和乙肝表面抗体(HBsAb)阳性率分别为4.58%(192/4 194)和63.92%(2 681/4 194)。<5岁、0~14岁、15~29岁、30~59岁人群HBsAg阳性率随年龄增加呈上升趋势(χ2=85.228,P<0.001),HBsAb阳性率呈现先下降后上升趋势(χ2=110.413,P<0.001)。 调查人群乙肝疫苗接种率为63.02%(2 643/4 194),接种率随年龄的增长呈逐渐下降趋势(χ2=2 229.121,P<0.001)。 多因素logistic分析结果显示,性别、乙肝疫苗接种史是影响成人HBsAg阳性率的主要因素,男性HBsAg阳性率高于女性(OR=1.404,95%CI:1.014~1.944),乙肝疫苗接种史者HBsAg阳性率低于无乙肝疫苗接种史者(OR=0.548,95%CI:0.371~0.810)。 结论浙江省儿童乙肝防控工作取得显著成绩,但需提高成年人乙肝疫苗接种率,加强乙肝抗原抗体检测,以利于成年人乙肝防控工作。 Abstract:ObjectiveTo investigate the serum markers of hepatitis B virus in healthy population in Zhejiang province in 2018. MethodsA questionnaire survey was conducted among 0–59 years old people with local residence >6 months who were selected through multistage stratified cluster random sampling, in 11 prefectures (municipality) and Yiwu of Zhejiang, and 2 ml of venous blood was collected from each study subjects for the detections of hepatitis B virus related antigen and antibody. ResultsA total of 4 194 people were investigated, the positive rate of HBsAg was 4.58% (192/4 194), and the anti-HBs rate was 63.92% (2 681/4 194). The positive rate of HBsAg in populations aged 0–14, 15–29 and 30–59 years increased with age ( χ2= 85.228, P<0.001). The positive rate of anti-HBs decreased first and then increased ( χ2=110.413, P<0.001). The immunization rate of hepatitis B vaccine was 63.02% (2 643/4 194). The vaccination rates decreased with age (χ2=2 229.121, P<0.001). The results of multivariate logistic analysis showed that gender and immunization history of hepatitis B vaccine were the main factors influencing the positive rate of HBsAg in adults. The positive rate of HBsAg was higher in men than in women (OR=1.404, 95%CI: 1.014–1.944). The positive rate of HBsAg was lower in patients with hepatitis B immunization history than in those without hepatitis B immunization history (OR=0.548, 95%CI: 0.371–0.810). ConclusionRemarkable achievements have been made in the prevention and control of hepatitis B in children in Zhejiang. It is beneficial for the prevention and control of hepatitis B in adults by increasing the immunization rate of hepatitis B vaccine and strengthening the detections of hepatitis B virus antigen and antibody in this population. -
表 1 2018年浙江省不同地区乙型肝炎血清标志物检测结果
Table 1. Detection results of serological markers of hepatitis B in different areas in Zhejiang, 2018
地区
(市)检测数
(份)乙肝表面抗原 乙肝表面抗体 本省 外省 总计 本省 外省 总计 杭州 299 5(2.17) 4(5.80) 9(3.01) 167(72.61) 40(57.97) 207(69.23) 宁波 270 15(9.43) 10(9.01) 25(9.26) 101(63.52) 74(66.67) 175(64.81) 温州 300 9(3.19) 0(0.00) 9(3.00) 207(73.40) 13(72.22) 220(73.33) 嘉兴 295 1(0.48) 1(1.18) 2(0.68) 142(67.62) 59(69.41) 201(68.14) 湖州 290 12(5.41) 3(4.41) 15(5.17) 125(56.31) 46(67.65) 171(58.97) 绍兴 300 3(1.12) 1(3.23) 4(1.33) 161(59.85) 18(58.06) 179(59.67) 金华 288 5(1.94) 4(3.33) 6(2.08) 141(54.65) 20(66.67) 161(55.90) 衢州 606 35(6.41) 4(6.67) 39(6.44) 325(59.52) 34(56.67) 359(59.24) 舟山 354 23(7.23) 3(8.33) 26(7.34) 207(65.09) 20(55.56) 227(64.12) 台州 325 7(2.85) 5(6.33) 12(3.69) 156(63.41) 45(56.96) 201(61.85) 丽水 281 6(2.22) 0(0.00) 6(2.14) 186(68.89) 11(100.00) 197(70.11) 义乌 586 26(7.72) 13(5.22) 39(6.66) 217(64.39) 166(66.67) 383(65.36) 合计 4 194 147(4.39) 45(5.31) 192(4.58) 2135(63.79) 546(64.46) 2681(63.92) 注:括号外数据为阳性数(份);括号内数据为阳性率(%) 表 2 2018年浙江省不同年龄组乙肝血清标志物检测结果
Table 2. Detection results of serological markers of hepatitis B in different age groups in Zhejiang, 2018
年龄组(岁) 检测数(份) 乙肝表面抗原 乙肝表面抗体 阳性数(份) 阳性率(%) 阳性数(份) 阳性率(%) 5 928 8 0.86 797 85.88 5~ 453 15 3.31 291 64.24 10~ 519 12 2.31 244 47.01 15~ 482 15 3.11 227 47.10 20~ 471 24 5.10 251 53.29 30~ 445 38 8.54 279 62.70 40~ 463 37 7.99 312 67.39 50~ 433 43 9.93 280 64.67 合计 4194 192 4.58 2681 63.92 表 3 2018年浙江省不同免疫史人群乙肝血清标志物检测结果
Table 3. Detection results of serological markers of hepatitis B in populations with different immunization history in Zhejiang, 2018
年龄组(岁) 有免疫史 无免疫史 检测数 乙肝表面抗原阳性 乙肝表面抗体阳性 检测数 乙肝表面抗原 乙肝表面抗体 0~ 1 889(99.42) 35(1.85) 1 328(70.30) 11 0(0.00) 4(36.36) 15~ 500(52.47) 17(3.40) 249(49.80) 453 22(4.86) 229(50.55) 30~ 254(18.94) 17(6.69) 254(68.11) 1 087 101(9.29) 698(64.21) 合计 2 643(63.02) 69(2.61) 1 750(66.21) 1 551 123(7.93) 931(60.03) 注:括号外数据为检测数(人)或阳性数(份);括号内数据为阳性率或接种率(%) 表 4 2018年浙江省15岁以上人群乙肝表面抗原相关影响因素分析
Table 4. Related factors for HBsAg in residents aged >15 years in Zhejiang,2018
变量 样本数
(份)乙肝表面抗原 单因素分析 阳性数(份) 阳性率(%) OR值(95%CI) P值 性别 1.418(1.031~1.951) 0.032 男性 927 76 8.20 女性 1 367 81 5.93 户籍 0.851(0.584~1.239) 0.399 本省 1 813 120 6.62 外省 481 37 7.69 疫苗接种 0.544(0.370~0.800) 0.002 是 754 34 4.51 否 1 540 123 7.99 -
[1] 崔富强, 庄辉. 中国乙型肝炎的流行及控制进展[J]. 中国病毒病杂志,2018,8(4):257–264.Cui FQ, Zhuang H. Epidemics and control of hepatitis B in China[J]. Chin J Viral Dis, 2018,8(4):257–264. [2] 国家卫生健康委疾病预防控制局, 中国疾病预防控制中心. 2014年全国1~29岁人群乙型病毒性肝炎血清流行病学调查报告[M]. 北京: 人民卫生出版社, 2019: 11, 47.Bureau of Disease Prevention and Control of the National Health Commission, Chinese Center for Disease Control and Prevention. The serological epidemiology survey of hepatitis B in the population aged 1–29 in China in 2014[M]. Beijing: People′s Medical Publishing House, 2019: 11, 47. [3] 周洋, 何寒青, 严睿, 等. 2005-2017年浙江省乙型肝炎流行病学特征[J]. 中国疫苗和免疫,2019,25(2):126–130.Zhou Y, He HQ, Yan R, et al. Epidemiology of hepatitis B in Zhejiang province during 2005−2017[J]. Chin J Vacc Immun, 2019,25(2):126–130. [4] 李倩, 刘瑶瑶, 马建新, 等. 2015年北京市朝阳区居民乙型病毒性肝炎病毒血清流行病学调查结果分析[J]. 疾病监测,2017,32(5):372–376. DOI: 10.3784/j.issn.1003−9961.2017.05.006.Li Q, Liu YY, Ma JX, et al. Sero-epidemiological survey of hepatitis B virus in Chaoyang district of Beijing, 2015[J]. Dis Surveill, 2017,32(5):372–376. DOI: 10.3784/j.issn.1003−9961.2017.05.006. [5] 邓秋云, 钟革, 刘巍, 等. 2018年广西壮族自治区1~59岁人群乙型肝炎血清流行率调查[J]. 中国疫苗和免疫,2020,26(1):25–29.Deng QY, Zhong G, Liu W, et al. Sero-prevalence of hepatitis B among people aged 1–59 years in Guangxi Zhuang Autonomous Region, 2018[J]. Chin J Vacc Immun, 2020,26(1):25–29. [6] 齐小秋, 王宇. 全国人群乙型病毒性肝炎血清流行病学调查报告[M]. 北京: 人民卫生出版社, 2011: 79.Qi XQ, Wang Y. The serological epidemiology survey of the hepatitis B in the population in China[M]. Beijing: People′s Medical Publishing House, 2011: 52–79. [7] The Polaris Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study[J]. Lancet Gastroenterol Hepatol, 2018,3(6):383–403. DOI: 10.1016/S2468−1253(18)30056−6. [8] Zhou Y, He HQ, Deng X, et al. Significant reduction in notification and seroprevalence rates of hepatitis B virus infection among the population of Zhejiang province, China, aged between 1 and 29 years from 2006 to 2014[J]. Vaccine, 2017,35(34):4355–4361. DOI: 10.1016/j.vaccine.2017.06.078. [9] 国家卫生计育委, 国家发展改革委, 教育部, 等. 中国病毒性肝炎防治规划(2017-2020年)[J]. 中国病毒病杂志,2018,8(1):1–5. DOI: 10.16505/j.2095−0136.2018.0001.National Health and Family Planning Commission, National Development and Reform Commission, Ministry of Education, et al. Action plan for the prevention and treatment of viral hepatitis in China (2017–2020)[J]. Chin J Viral Dis, 2018,8(1):1–5. DOI: 10.16505/j.2095−0136.2018.0001. [10] 岳晨妍, 李迪, 李燕, 等. 中国5个县儿童乙型病毒性肝炎疫苗接种和血清学调查[J]. 中国疫苗和免疫,2018,24(3):274–279.Yue CY, Li D, Li Y, et al. Vaccination coverage and seroprevalence of hepatitis B among children in five counties of China[J]. Chin J Vacc Immun, 2018,24(3):274–279. [11] 姚军. 浙江省疫苗针对性疾病流行病学[M]. 杭州: 浙江科学技术出版社, 2018: 8–9.Yao J. Epidemiology of vaccine targeted diseases in Zhejiang[M]. Hangzhou: Zhejiang Science and Technology Press, 2018: 8–9. [12] 王富珍, 张国民, 沈丽萍, 等. 1992和2014年中国不同流行地区1~29岁人群乙型肝炎血清流行病学调查结果对比分析[J]. 中华预防医学杂志,2017,51(6):462–468. DOI: 10.3760/cma.j.issn.0253−9624.2017.06.002.Wang FZ, Zhang GM, Shen LP, et al. Comparative analyze on hepatitis B seroepidemiological surveys among population aged 1–29 years in different epidemic regions of China in 1992 and 2014[J]. Chin J Prev Med, 2017,51(6):462–468. DOI: 10.3760/cma.j.issn.0253−9624.2017.06.002. [13] World Health Organization. Hepatitis B vaccines[J]. Wkly Epidemiol Rec, 2009,84(40):405–419. [14] 徐爱强, 张丽. 中国成年人乙型肝炎疫苗免疫策略的循证与思考[J]. 中华预防医学杂志,2016,50(6):473–477. DOI: 10.3760/cma.j.issn.0253−9624.2016.06.001.Xu AQ, Zhang L. Immunization strategy of hepatitis B vaccine among adults in China: evidence based-medicine and consideration[J]. Chin J Prev Med, 2016,50(6):473–477. DOI: 10.3760/cma.j.issn.0253−9624.2016.06.001. [15] 马田莉, 潘璐璐, 高招, 等. 河北省成年人乙肝疫苗接种率影响因素研究[J]. 中国预防医学杂志,2019,20(4):303–307.Ma TL, Pan LL, Gao Z, et al. Influencing factors of coverage rate of hepatitis B vaccine among adults in Hebei province[J]. Chin Prev Med, 2019,20(4):303–307. [16] 王贵强, 段钟平, 王福生, 等. 慢性乙型肝炎防治指南(2019年版)[J]. 实用肝脏病杂志,2020,23(1):S9–32. DOI: 10.3969/j.issn.1672−5069.2020.01.044.Wang GQ, Duan ZP, Wang FS, et al. The guidelines of prevention and treatment for chronic hepatitis B (2019 version)[J]. J Pract Hepatol, 2020,23(1):S9–32. DOI: 10.3969/j.issn.1672−5069.2020.01.044. [17] 郑徽, 王富珍, 张国民, 等. 中国社区成年人群HBsAg阳性者医疗和就诊行为及相关影响因素研究[J]. 中华流行病学杂志,2016,37(4):455–459. DOI: 10.3760/cma.j.issn.0254−6450.2016.04.003.Zheng H, Wang FZ, Zhang GM, et al. Study on health-seeking behavior and influencing factors among Chinese hepatitis B surface antigen positive adults[J]. Chin J Epidemiol, 2016,37(4):455–459. DOI: 10.3760/cma.j.issn.0254−6450.2016.04.003. [18] WHO. Global hepatitis report, 2017[EB/OL]. (2017−04)[2020−03−13]. https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/. -
0100:2018年浙江省健康人群乙肝血清流行病学调查分析.docx
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