乙型肝炎病毒感染对健康影响的队列研究

目的:探讨乙型肝炎病毒(HBV)感染对健康的影响。方法:在原发性肝癌(HCC)高发区江苏省海门市建立前瞻性研究队列人群,对研究对象进行流行病学调查,采集外周静脉血检测HBsAg及其他相关指标,每年随访队列成员的生命状况及死因。以HBsAg作为HBV感染指标,比较HBsAg暴露和阴性组人群的死亡密度。并应用COX风险模型探讨HBV感染在原发性肝细胞癌(HCC)发生中的风险率比(HR)。结果:HBsAg暴露组人群的死亡密度为1482.35/10万人年,是对照组的3.42倍。HCC是研究组的首位死因,占全部死亡的52.28%,与对照组相比RR=15.63,AR=93.60%。男性HR=22.3,95%CI 18.7~26.6,女性HR=37.2,95%CI=19.1~72.5。结论:感染HBV对机体健康有明显影响。     

Antibody to hepatitis A virus after overt and asymptomatic hepatitis A infection

The titres of antibody to hepatitis A virus (anti-HAV) were found to fall rapidly during 3–4 years after hepatitis A and more slowly thereafter, though they never reached undetectable levels in at least 23 years. The levels of anti-HAV in convalescents after overt hepatitis A were found to be significantly much higher than in those who had anti-HAV as a result of asymptomatic infection.Corresponding author.     

Inapparent infection of hepatitis A virus

To detect inapparent infection with hepatitis A virus, serial sera were collected from patients with hepatitis A and their contacts in two waterborne epidemics in China. Epidemic 1 occurred in a rural village near Hangzhou during August 1978-January 1979, and epidemic 2 took place in a rural primary school in Pinghu County in Zhejiang in April-May 1985. These sera were tested for antibodies against hepatitis A virus (anti-HAV), serum glutamic pyruvic transaminase (SGPT) activity, and icteric index. Feces also were collected in epidemic 1 to test for hepatitis A virus antigen. Both anti-HAV immunoglobulin M (IgM) and total anti-HAV were assayed in sera from "healthy persons" (symptomless persons without icterus and with normal SGPT level) who were in close contact with hepatitis A patients. In epidemic 1, among 18 "healthy persons", 12 were anti-HAV IgM positive, two were immune, and four susceptibles escaped infection. In epidemic 2, among 32 "healthy children", three were anti-HAV IgM positive, five had been infected by hepatitis A virus in the past, and 24 were not infected. These results demonstrate that inapparent infections occur along with overt and subclinical infections during epidemics of hepatitis A. The proportions of inapparent, subclinical, and overt infections were, respectively, 34.3%, 45.7%, and 20% in epidemic 1, and 25%, 50%, and 25% in epidemic 2. In addition, hepatitis A virus particles were demonstrated in the feces of all infected subjects who were examined and who included all levels of clinical response. These particles were identified with immuno-electron microscopy and enzyme-linked immunoassay.     

Degree of hepatitis C infection risk in the health care setting

BACKGROUND: Hepatitis C virus is the most important aetiologic agent for non A-non B hepatitis. The study of the prevalence of hepatitis C in health care workers is of primary interest because of the possible chronic evolution and the risk of cirrhosis and liver cancer. OBJECTIVES: The purpose of this study was to determine the prevalence of HCV among health care workers in 5 main hospitals and local health units in Turin and analyze the influence of occupational and non occupational risk factors. METHODS: Health care personnel were administered anonymous questionnaires and testing for anti-HCV antibody was performed. RESULTS: Prevalence rates in 4517 health care workers was 1.97%; the prevalence was higher in elderly workers (> 45 years) than in younger ones. The risk analysis did not reveal any significant correlation between HCV seroconversion and accidental blood exposure. However, a significant correlation was found with non-occupational risk factors. Unapparent infection was an unimportant risk factor for seroconversion. CONCLUSIONS: Hepatitis C prevalence in the population under study was comparable to that found in the general population. These results point to the need to reconsider the assumption that there is an increase of risk of seroconversion for health-care workers, in the absence of any occupational accidental exposure to hepatitis C virus.     

Seroepidemiology of infection with hepatitis A virus and hepatitis B virus in the Seychelles

A batch of 417 serum samples obtained from native-born subjects were tested for the presence of hepatitis B surface antigen (HBsAg) and corresponding antibody (anti-HBs), by enzyme-linked immunosorbent assay (ELISA); and antibodies to hepatitis B core antigen (anti-HBc), e-antigen (anti-HBe), and hepatitis A virus (anti-HAV), by radioimmunoassay (RIA). HBsAg was found in only two of the 417 subjects studied. Anti-HBs was detected in 112 samples (26.8%), anti-HBc in 114 (27.3%) and anti-HBe in 31 samples (7.4%). Serologic evidence of a previous or present infection by hepatitis B virus (HBV) was found in 34.5% of the samples studied. Males showed a greater prevalence of anti-HBs and anti-HBc, while anti-HBe was more common in females; however, these differences were not significant. With regard to age, a significantly higher prevalence of anti-HBs (p less than 0.05), anti-HBc (p less than 0.025) and anti-HBe (p less than 0.025) was found in the older age groups. Anti-HAV antibodies were present in 90% of the subjects studied, with no variation between the sexes. The anti-HAV rate in the group under 20 years was similar to that found in the older age groups. The total infection rate of hepatitis B virus in the Seychelles is lower than in other tropical areas, HBs antigen/antibody ratio approaching that in temperate areas. Elucidation of the reasons for the low prevalence of hepatitis B virus carriers among the Sevchelles population requires further investigation.     

乙型肝炎病毒宫内感染危险因素研究

目的 研究乙型肝炎病毒(HBV)宫内感染的危险因素.方法 采用巢式病例对照研究的方法,进行HBV宫内感染危险因素的logistic回归分析.结果 HBV宫内感染危险因素的单因素分析显示在α=0.05水平上,孕妇DR3、婴儿DR3、母婴DR3同阳性、孕妇血清HBV DNA阳性、孕妇血清HBeAg阳性和胎盘感染在病例组和对照组差异均有统计学意义;是HBV官内感染的危险因素,OR值(95%CI)分别为4.71(1.62～13.66)、3.91(1.18～12.94)、5.96(1.14～31.15)、6.59(2.72～15.97)、4.53(1.93～10.64)和2.51(1.12～5.60);在α入=0.05,α出=0.10水平上,进行HBV宫内感染的多因素logistic回归分析,孕妇DR3(OR=4.65,1.44～15.05)、孕妇血清HBV DNA(OR=6.56,2.65～16.23)被引入回归方程,为HBV宫内感染的危险因素,且两因素间未显示交互作用;其他因素的暴露率在病例组和对照组未见明显差别.随着孕妇血清HBV DNA含量的增加,其发生宫内感染的危险性呈现增高趋势(χ2=16.74,P＜0.os).结论 HBV宫内感染的危险因素为孕妇HLA-DR3阳性和孕妇血清HBV DNA阳性,且两因素间未显示交互作用,HBV宫内感染率随孕妇血中HBVDNA含量增高呈增高趋势.     

Risk groups for hepatitis A virus infection

We report the conduct and results of a systematic search for evidence of risk of infection with hepatitis A virus (HAV) among blood transfusion recipients, travellers, the military, healthcare workers, sewage workers, foodhandlers, day care assistants, institutionalised subjects, blood transfusion recipients, drug addicts, homosexuals, prisoners and other risk groups such a liver transplantees. We report our recommendations for the use of the HAV vaccine in these groups.     

丙型肝炎病毒感染主要危险因素的Meta分析

目的 分析丙型肝炎病毒(HCV)感染的危险因素。方法计算机检索中国医院知识仓库(CHKD)、万方数据知识平台、EBSCO、西文生物医学期刊文献服务系统、Elsevier,并结合文献追溯的方法,收集1994-2010年公开发表的关于HCV感染危险因素的文献,研究类型为病例对照研究或队列研究,采用RevMan 5.0及St...     

行为危险因素与乙型肝炎病毒感染者不同结局的关联研究

目的 了解影响乙型肝炎病毒(HBV)感染不同结局的相关因素,为采取有针对性的控制措施提供科学依据.方法 采用整群随机抽样的方法,选取慢性HBV患者207人,自限性HBV感染者148人,对可能影响HBV感染结局的影响因素进行问卷调查,采用Logistic回归分析方法.结果 经常在外就餐在慢性HBV组和自限性HBV感染组有统计学差异(P=0.0006);每天吸烟量在10支以上者和每月饮酒量在100个饮酒单位者在两组间存在统计学差异(P=0.0017和P=0.0003).结论 不良生活习惯影响HBV感染的结局,应加强HBV感染者的健康教育,改变不良生活方式,有利于减缓HBV感染的慢性化进程.     

The risk of infection with hepatitis B virus in relation to length of hospital employment

A sero-epidemiological study was carried out on a representative sample of employees of the Hospital Clinico ‘San Cecilio’ in an attempt to quantify the influence of the time spent working in the hospital on the risk of becoming infected by hepatitis B virus. The results show that the rate of infection by HBV is directly proportional to the length of employment in the hospital, with a probability of infection between 0·6% and 1·4% for each working year.     

社区儿童乙型肝炎病毒感染危险因素病例对照研究

目的分析儿童乙型肝炎(以下简称乙肝)病毒感染的危险因素,为降低乙肝病毒感染率提供依据。方法采用多阶段随机整群抽样方法,利用社区人群乙肝血清流行病学调查资料,对502例乙肝病毒感染儿童和2 046例未感染乙肝病毒儿童感染相关因素信息进行整理,应用SPSS 13.0软件进行分析。结果单因素分析显示:年龄、性别、出生地、乙肝家庭史、手术史、乙肝疫苗接种史6个因素差异有统计学意义(P0.01),多因素分析显示:大年龄、女性、有乙肝家庭史是乙肝病毒感染的危险因素,接种乙肝疫苗是保护因素。结论扩大免疫人群,尤其是尽早对家庭内有乙肝病毒携带者的其他易感成员接种乙肝疫苗,同时在巩固乙肝疫苗高接种率的基础上,提高首针接种及时率是降低乙肝病毒感染率的关键措施。     

Population-attributable risk of dietary aflatoxins and hepatitis B virus infection with respect to hepatocellular carcinoma

BACKGROUND: Aflatoxins and hepatitis B virus (HBV) infections are important risk factors of hepatocellular carcinoma (HCC). This study assesses the population-attributable risk of these two factors, both jointly and separately, with respect to HCC. METHODS: A case-control study was conducted in Sudan between 1996 and 1998. Among 114 cases and 198 controls the consumption of peanut butter (a major source of aflatoxins) and HBV infection were investigated, as were drinking and smoking habits. RESULTS: A clear dose-response relation was observed between increasing peanut butter consumption and HCC in people without HBV infection. Age-adjusted odds ratios for peanut butter consumption, HBV infection, and for the combination of both factors were, respectively, 5.1 (95% confidence interval = 1.8-13.9), 32.2 (4.0-257), and 41.5 (11.2-155). In this study, about 80% of the HCC cases are attributable to either peanut butter consumption or HBV infection. Depending on assumptions in the data analysis, 27-60% of all cases can be attributed to aflatoxin exposure and 49-52% to HBV infection; of these figures, 7-34% reflect a shared responsibility of the two factors. CONCLUSIONS: Both reduction of aflatoxin contamination of foods and HBV vaccination may be useful public health strategies in HCC prevention in Sudan.     

新疆部分高危人群庚型肝炎病毒感染状况

目的 了解庚型肝炎病毒（ＨＧＶ）在新疆不同高危人群中的感染状况,为全疆病毒性肝炎的防治提供科学依据。方法 酶联免疫测定法检测血清标本中抗－ＨＧＶ。结果 非甲－戊型肝炎患中抗－ＨＧＶ检出率为２３．４６％,慢性乙型肝炎及丙型肝炎患中抗－ＨＧＶ检出率分别为１０．００％和１５．００％,静脉吸毒中抗－ＨＧＶ检出率为６．９６％,职业献血员中抗－ＨＧＶ检出率为９．０２％,不同地区之间存在差异,血液透析中     

Sexual risk for hepatitis B virus infection among hepatitis C virus-negative heroin and cocaine users

Hepatitis C virus (HCV) and hepatitis B virus (HBV) are highly prevalent, often co-occurring infections among drug users. We examined HBV prevalence and risk behaviour patterns among a group of HCV-negative heroin and/or cocaine users in order to understand HBV risk and prevention opportunities among this unique group. Of 164 people enrolled, 44% had injected drugs. Overall, 24% of participants tested positive for exposure to HBV; drug injectors (28%) were only slightly and not significantly (P=0.287) more likely to test positive than those who had never injected drugs (21%). HBV exposure was significantly associated with multiple indicators of greater sex risk. HBV status was not associated with any demographic characteristic, but participants who reported longer duration of cocaine use were significantly less likely to test positive to exposure for HBV. It appears that HBV risk among HCV-negative drug users in this cohort is primarily due to sexual behaviour.     

Human genetic susceptibility to hepatitis B virus infection

Hepatitis B virus (HBV) infection is still a serious health threat worldwide. The outcomes of HBV infection consist of spontaneous HBV clearance and chronic HBV infection. Multiple factors contribute to the disparity of HBV infection outcomes, including host factors, viral factors and environmental factors. The present review comprehends the current researches mainly focusing on the relationships between genetic determinants, including single nucleotide polymorphisms (SNPs) and haplotypes, and susceptibility of HBV infection, namely chronic (persistent) HBV infection and HBV clearance. A number of determinants in the chromosomes, including mutations in human leukocyte antigens (HLAs), cytokines genes, toll-like receptors (TLRs), and other genes are related to the human susceptibility to HBV infection. Among the above variants, some of those in HLAs have been studied and replicated in multiple-ethnic populations and came to consistent conclusions, while some others are novel and need to be evaluated further.     

维持性血液透析患者感染乙型肝炎和丙型肝炎病毒的危险因素分析

目的分析维持性血液透析患者感染乙型肝炎和丙型肝炎病毒的高危因素,为临床感染的预防和治疗提供借鉴依据。方法选取2014年10月-2015年10月医院临床收治的维持性血液透析患者368例为研究对象,分析维持性血液透析患者的乙型肝炎和丙型肝炎病毒感染情况、导致感染的危险因素及相关临床特点。结果共39例患者发生感染,感染率为10.60%;年龄、住院时间、透析总次数、肝炎病史、透析器复用是导致维持性血液透析患者肝炎病毒感染的独立危险因素(P<0.01);感染患者的血红蛋白、血清白蛋白均低于非感染患者,感染患者C-反应蛋白、丙氨酸转氨酶和天冬氨酸转氨酶均高于非感染患者,感染患者的各项淋巴细胞亚群指标均低于非感染患者,组间上述指标比较,差异均有统计学意义(P<0.05)。结论维持性血液透析患者肝炎病毒感染较为严重,危险因素较多,患者遭受感染后临床特点主要表现为营养状况下降、肝脏受损情况加剧、机体免疫能力低下等。     

婚检人群乙肝感染情况的研究进展

婚检即婚前体格检查,是《母婴保健法》中规定的专项技术服务之一,通过早期筛选,找出影响结婚生育的关病,并针对具体怦进行次询指导,达到促进健康婚配,阻止遗传性疾病的延续,提高人口素质的目的。     

Estimated incidence of hepatitis A virus infection in Catalonia

PURPOSE: Hepatitis A normally is underreported by statutory disease reporting systems. The objective of this study is to estimate the incidence of hepatitis A virus (HAV) infection from prevalence surveys of infection carried out in representative samples of the population in 1989, 1996, and 2002 and the reported disease incidence during 1991 to 2003 in Catalonia. METHODS: The real incidence of the infection was estimated from the reported incidence adjusted by the prevalence of susceptible individuals and the probability of presenting clinical manifestations. The bootstrap resampling technique was used to calculate 95% confidence intervals (CIs) of reported, clinical, and all infection cases. RESULTS: The infection rate estimated by the bootstrap method was 31.1/100,000 person-years (bootstrap studentized 95% CI, 19.4-56.0), and the rate of clinical hepatitis was 20.0/100,000 person-years (95% CI, 11.8-39.9), rates that were 6.3 and 4.1 times greater than the reported rate during the same period, respectively. CONCLUSIONS: In children younger than 5 years, the estimated infection rate was 13.8 times greater than the reported rate. Combined use of reported cases and results of seroprevalence surveys suggest that underreporting of HAV infection is substantial in Catalonia, especially in children younger than 5 years.     

Injections in health care settings: a risk factor for acute hepatitis B virus infection in Karachi,Pakistan

A case control study was conducted to identify the association of therapeutic injections with acute hepatitis B virus (HBV) infection in Karachi, Pakistan. We enrolled 67 cases of acute HBV infection (IgM anti-HBc positive) and 247 controls (anti-HBc negative) from four hospitals of Karachi during July 2000-June 2001. Exposure to various risk factors during the period relevant to the incubation period of HBV was recorded both from cases and controls using a structured questionnaire. Multivariate logistic regression analysis of the data showed that cases were more likely to have received one injection (OR = 4.0; 95 % CI 1.4, 11.1), or more than one injection (OR = 6.3; 95 % CI 3.2, 12.4) compared to controls. The estimated population attributable risk (PAR) for therapeutic injections was 53%. Also the cases compared to controls were more likely to have household size of seven or more (OR = 1.9; 95 % CI 0.95, 3.9). This study showed that unsafe therapeutic injections appear to be the major risk factor for acute HBV infection and needs immediate focus from public health stand point.