文章摘要
朱立国,姜洁,宋词,邹艳,徐建芳,刘红建,彭红,胡志斌,朱凤才,沈洪兵,翟祥军.江苏省2012-2014年HBeAg阳性慢性HBV感染者HBeAg阴转的特征分析[J].中华流行病学杂志,2017,38(2):179-184
江苏省2012-2014年HBeAg阳性慢性HBV感染者HBeAg阴转的特征分析
A cohort study on the epidemiological characteristics of HBeAg sero-clearance in HBeAg positive chronic hepatitis B patients in Jiangsu province from 2012 to 2014
收稿日期:2016-08-09  出版日期:2017-02-17
DOI:10.3760/cma.j.issn.0254-6450.2017.02.009
中文关键词: 肝炎病毒,乙型;乙肝e抗原;阴转;队列
英文关键词: HBV;Hepatitis B e antigen;Clearance;Cohort
基金项目:国家科技重大专项(2009ZX10004-904,2011ZX10004-902,2013ZX10004-905);国家自然科学基金(81502861)
作者单位E-mail
朱立国 210009 南京, 江苏省疾病预防控制中心重大专项执行办公室  
姜洁 210009 南京, 江苏省疾病预防控制中心重大专项执行办公室  
宋词 210029 南京医科大学公共卫生学院  
邹艳 215600 江苏省张家港市疾病预防控制中心防疫科  
徐建芳 212310 丹阳市疾病预防控制中心防疫科  
刘红建 225400 泰兴市疾病预防控制中心重大专项执行办公室  
彭红 210009 南京, 江苏省疾病预防控制中心重大专项执行办公室  
胡志斌 210029 南京医科大学医药实验动物中心  
朱凤才 210009 南京, 江苏省疾病预防控制中心重大专项执行办公室  
沈洪兵 210029 南京医科大学公共卫生学院  
翟祥军 210009 南京, 江苏省疾病预防控制中心重大专项执行办公室 jszxj@jscdc.cn 
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中文摘要:
      目的 了解HBeAg阳性慢性HBV感染者发生HBeAg阴转的流行病学特征,为推进慢性HBV感染者的规范管理提供依据。方法 2012-2014年对江苏省传染病防治示范区HBeAg阳性慢性HBV感染者队列开展定期随访。通过Cox回归分析HBeAg阳性慢性HBV感染者HBeAg阴转特征及影响因素,通过重复测量数据方差分析方法分析不同HBeAg转归者HBV DNA的变化趋势。结果 2012年721例HBeAg阳性慢性HBV感染者(平均年龄45.2岁±14.2岁)随访到2014年时393例发生HBeAg阴转,观察1 058人年,HBeAg阴转率为37.2/100人年。有抗病毒治疗史的感染者HBeAg阴转率为32.4/100人年。年长者的HBeAg阴转率较高,从<20岁年龄组的7.0/100人年上升到≥60岁年龄组的62.0/100人年。HBV DNA<2 000 IU/ml的感染者HBeAg阴转率为75.8/100人年,高于≥200 000 IU/ml者的阴转率(16.1/100人年)。通过Cox多元回归分析,相对于HBV DNA<2 000 IU/ml者,HBV DNA≥200 000 IU/ml的感染者HBeAg阴转可能性降低(HR=0.18,95%CI:0.13~0.23,P<0.001)。HBeAg阴转组的HBV DNA较HBeAg持续阳性组下降更快(P<0.001)。结论 HBeAg阳性慢性HBV感染者HBeAg阴转率与年龄和HBV病毒载量有关,对不同特征的HBeAg阳性感染者应采取针对性的管理和干预措施。
英文摘要:
      Objective To understand the epidemiological characteristics and influencing factors related to HBeAg sero-clearance in chronic hepatitis B patients so as to provide evidence for regular management on chronic HBV patients. Methods From 2012 to 2014, a cohort study was conducted among HBeAg positive chronic HBV patients in Jiangsu province. Association between the characteristics and incidence of HBeAg sero-clearance was analyzed by Cox regression method. The changing trend on HBV DNA between patients with HBeAg sero-clearance and those with persistent HBeAg positive status was compared by repeated measure data variance analysis method. Results In 2012, there were 721 HBeAg positive hepatitis B patients aged (45.2±14.2) years enrolled in this study. By 2014, the follow-up observation period was 1 058 person-years, and 393 cases had lost their HBeAg status, with the rate as 37.2/100 person-years. The HBeAg sero-clearance rate was 32.4/100 person-years in hepatitis B patients who received antiviral treatment. The probability of HBeAg clearance in HBeAg positive hepatitis B patients aged ≥60 year (62.0/100 person-years) was higher than those of aged <20 year (7.0/100 person-years). The rate of HBeAg sero-clearance in HBeAg positive patients with HBV DNA <20 000 IU/ml (75.8/100 person-years) was higher than those whose HBV DNA were ≥200 000 IU/ml (16.1/100 person-years). By Cox regression analysis, the HBV DNA level was an important influencing factor on the progress of HBeAg sero-clearance. Patients with HBV DNA levle as ≥200 000 IU/ml, had a lower HBeAg clearance rate (HR=0.18, 95%CI:0.13-0.23, P<0.001). Compared to the persistent HBeAg positive group, HBV DNA showed a more dramatic fall in the HBeAg-lost group (P<0.001). Conclusion The rate of HBeAg sero-clearance among HBeAg positive hepatitis B patients was correlated with age and HBV DNA status of the patients that called for comprehensive management and intervention programs to develop for the HBeAg positive hepatitis B patients with different characteristics.
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