江苏省丹阳市465例丙型肝炎病毒感染者自然转归及相关因素调查

许可; 鲍倡俊; 王洁; 朱立国; 徐建芳; 彭红; 翟祥军

Abstract

许可,鲍倡俊,王洁,朱立国,徐建芳,彭红,翟祥军.江苏省丹阳市465例丙型肝炎病毒感染者自然转归及相关因素调查[J].Chinese journal of Epidemiology,2017,38(2):194-199

江苏省丹阳市465例丙型肝炎病毒感染者自然转归及相关因素调查

Prognosis and related risk factors for 465 subjects infected with hepatitis C virus in Danyang, Jiangsu province

Received:August 31, 2016

DOI：10.3760/cma.j.issn.0254-6450.2017.02.012

KeyWord: 丙型肝炎病毒转归危险因素

English Key Word: Hepatitis C virus Prognosis Risk factors

FundProject:国家自然科学基金（81473028）；国家科技重大专项（2009ZX10004-904，2011ZX10004-902，2013ZX10004-905）

Author Name	Affiliation	E-mail
Xu Ke	Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Bao Changjun	Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Wang Jie	School of Nursing, Nanjing Medical University, Nanjing 210029, China
Zhu Liguo	Department of National Science and Technology Major Project, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Xu Jianfang	Department of Acute Infectious Disease Prevention and Control, Danyang Center for Disease Control and Prevention, Danyang 212300, China
Peng Hong	Department of National Science and Technology Major Project, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Zhai Xiangjun	Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China Department of National Science and Technology Major Project, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China	jszxj@jscdc.cn

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Abstract:

目的了解HCV感染者感染多年后临床和病原特征及其相关因素。方法 2012年在江苏省丹阳市对465例HCV感染者开展问卷调查、临床体征检查、血生化检测、病原检测，以明确感染者转归情况，对不同转归的感染者通过多因素logistic回归方法分析人口学特征、行为习惯、人类白细胞抗原DQ基因单核苷酸位点（rs7453920和rs2856718）、病原特征等因素对转归的影响。结果 465名HCV感染者临床表现主要为乏力（15.70%，73/465），消化道症状（17.63%，82/465），关节痛（10.32%，48/465），B超肝炎病变（11.83%，55/465），ALT值>80 IU/L（12.70%，59/465），AST值>80 IU/L（11.18%，52/465）。HCV RNA阳性占68.60%（319/465），病毒载量M为76.01×10⁴拷贝数/ml（592~1.08×10¹⁰拷贝数/ml）。多因素分析显示男性相比女性（OR=2.298，95%CI：1.247~4.238）、rs2856718的GA型相比AA基因型（OR=1.716，95%CI：1.070~2.752）、饮酒每周≥7次（OR=2.966，95%CI：0.979~8.988）是HCV持续感染的相关危险因素；男性（OR=1.694，95%CI：0.975~2.942）、50~岁年龄组（OR=2.414，95%CI：1.156~5.042）、有其他肝脏疾病（OR=2.592，95%CI：1.105~6.079）以及HCV RNA阳性（OR=3.479，95%CI：1.648~7.343）是肝功能异常的相关危险因素。结论 HCV感染20~30年后，病毒持续感染和肝功能异常的比例高，年龄、性别、嗜酒、个体基因特征、基础疾病是影响HCV感染转归的相关危险因素。

English Abstract:

Objective To investigate the clinical features and viral load of persons infected with HCV and the risk factors for severe outcomes. Methods Medical testing and questionnaire survey were conducted on 465 cases who were infected with HCV, 20-30 years back. HCV RNA, alanine transaminase (ALT), aspartate transaminase (AST), albumin, globulin and bilirubin were tested for these subjects. Factors as demography, tobacco and alcohol consumption, SNP of rs7453920 and rs2856718 on HLA-DQ gene of subjects with HCV RNA, were analyzed by multiple logistic regression method to explore the risk factors for severe outcomes among the patients. Result Totally, 465 subjects had symptoms as hypodynamic (15.70%, 73/465), digestive system (17.63%, 82/465), and arthrodynia (10.32%, 48/465). HCV RNA was positive in 68.60% (319/465) of the subjects with median viral load as 76.01×10⁴ copies/ml (min-max:592 copies/ml-1.08×10¹⁰ copies/ml). Totally, 11.83% (55/465) of the cases appeared having liver inflammation by routine ultrasound exams. ALT and AST was seen higher than 80 (IU/L) in 12.70% (59/465) and 11.18% (52/465) of the subjects, separately. Factors as being male (OR=2.298, 95%CI:1.247-4.238), GA genotype compared with AA type in rs2856718 (OR=1.716, 95%CI:1.070-2.752), alcohol intake ≥7 times per-week (OR=2.966, 95%CI:0.979-8.988) etc., were independently related to HCV RNA sustained positivity. Factors as:being male (OR=1.694, 95%CI:0.975-2.942), in 50-59 years age group (OR=2.414, 95%CI:1.156-5.042), having other liver diseases (OR=2.592, 95%CI:1.105-6.079) and carrying positive HCV RNA (OR=3.479, 95%CI:1.648-7.343) etc. were independent risk factors for abnormal liver function. Conclusion High rates of carrying sustained positive HCV RNA and abnormal liver function appeared in subjects who got the HCV infection 20-30 years ago. Factors as being male, in old age, being frequent alcohol taker, GA genotype in rs2856718 and with other liver diseases etc. were related to higher risk for developing severe outcomes.

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