社区人群HBsAg携带者再激活相关危险因素的巢式病例对照研究

目的 探讨社区人群乙型肝炎病毒表面抗原( hepatitis B surface antigen,HBsAg)携带者发生HBV再激活的危险因素。方法 2011年在甘肃省武威市乙型肝炎防治示范区建立HBsAg携带者队列,并进行了基线调查,随后分别于2012年、2014年和2018年对该队列进行了3次随访,同时采集血液标本和进行流行病学问卷调查,根据血清流行病学资料,将符合HBV再激活判定标准的119例纳入病例组,随机抽取282例HBsAg携带者作为对照组,采用t检验、χ²检验和logistic回归分析方法,分析HBV再激活的危险因素。结果 发生HBV再激活病例的平均年龄为（50.05±12.17）岁,男性占67例（56.3%）,女性52例（43.7%）。多因素logistic回归分析结果表明：吸烟（OR=2.145,95%CI：1.134~4.061）、一年内多次感冒（OR=2.020,95%CI：1.188~3.433）、经历负性生活事件（OR=2.069,95%CI：1.208~3.545）与HBV再激活呈正相关。结论 吸烟、一年内多次感冒、经历负性生活事件是HBV再激活的危险因素,应加强对HBsAg携带者的随访管理和宣传教育,定期评估抗病毒治疗时机,防止HBV携带者不良转归的发生发展。

Nested case-control study on risk factors of HBsAg carrier reactivation in a community population

Objective To investigate the risk factors of HBV reactivation in hepatitis B virus surface antigen (HBsAg) carriers in a community population. Methods A cohort of HBsAg carriers was established in Wuwei City, Gansu Province in 2011. At the same time, a baseline survey was conducted. And the follow-up were conducted three times in 2012, 2014 and 2018. At the same time, blood samples were collected and an epidemiological questionnaire was used to survey. Based on the sero-epidemiological data, 119 patients who met the HBV reactivation criteria were included in the case group and 282 HBsAg carriers were randomly selected as the control group. T-test, χ² test, and multivariate logistic regression analysis were used to analyze the risk factors for HBV reactivation. Results The average age of cases with HBV reactivation was （50.05±12.17 ）years old, among them males were 67 cases(56.3%) and females were 52 cases (43.7%). Multivariate logistic regression analysis indicated that smoking (OR=2.145,95%CI1.134-4.061), cold occurred many times in a year (OR=2.020,95%CI1.188-3.433) and experiencing negative life events (OR=2.069,95%CI1.208-3.545) were positively correlated with HBV reactivation.Conclusion A number of factors, such as smoking, cold occurred many times in a year and experiencing negative life events are risk factors of HBV reactivation. Regular follow-up management and health education should be strengthened for HBsAg carriers, and the opportunity of antiviral treatment should be evaluated regularly to prevent the development of adverse outcome of HBV carriers.