江苏省非活动性HBsAg携带者代谢性疾病危险因素对乙型肝炎再活动影响的队列研究

徐建芳; 姜洁; 杨丽; 钱姣; 王涵; 陈海明; 刘红建; 宋词; 徐昕; 朱凤才; 朱立国; 翟祥军

Abstract

徐建芳,姜洁,杨丽,钱姣,王涵,陈海明,刘红建,宋词,徐昕,朱凤才,朱立国,翟祥军.江苏省非活动性HBsAg携带者代谢性疾病危险因素对乙型肝炎再活动影响的队列研究[J].Chinese journal of Epidemiology,2022,43(8):1301-1308

江苏省非活动性HBsAg携带者代谢性疾病危险因素对乙型肝炎再活动影响的队列研究

Association between metabolic risk factors and the hepatitis B reactivation of inactive HBsAg carriers in Jiangsu province: a cohort study

Received:December 03, 2021

DOI：10.3760/cma.j.cn112338-20211203-00944

KeyWord: 慢性乙型肝炎代谢性疾病队列研究非活动性乙型肝炎表面抗原携带者乙型肝炎再活动

English Key Word: Chronic hepatitis B Metabolic diseases Cohort studies Inactive HBsAg carriers Hepatitis B reactivation

FundProject:国家科技重大专项（2018ZX10715-002）；国家自然科学基金（81502861，81673244）；江苏省青年医学人才（QNRC2016546）；江苏省第五期“333工程”（BRA2018399）；江苏省卫生健康委科研课题（H2018096，Y2018071）

Author Name	Affiliation	E-mail
Xu Jianfang	Department of Acute Infectious Diseases Control and Immunization Programmes, Danyang County Center for Disease Control and Prevention, Danyang 212310, China
Jiang Jie	Major Project Executive Office, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Yang Li	School of Public Health, Xiamen University, Xiamen 361102, China
Qian Jiao	Major Project Executive Office, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Wang Han	School of Public Health, Nanjing Medical University, Nanjing 210029, China
Chen Haiming	Department of Infectious Disease Control, Zhangjiagang County Center for Disease Control and Prevention, Zhangjiagang 215600, China
Liu Hongjian	Major Project Executive Office, Taixing County Center for Disease Control and Prevention, Taixing 225400, China
Song Ci	Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing 210029, China
Xu Xin	Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing 210029, China
Zhu Fengcai	Key Laboratory of Intestinal Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Zhu Liguo	Key Laboratory of Intestinal Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Zhai XiangJun	Major Project Executive Office, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China	jszxj@jscdc.cn

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Abstract:

目的分析代谢性疾病危险因素等对非活动性HBsAg携带者（IHC）发生乙型肝炎（乙肝）再活动的流行病学特征，为规范慢性HBV感染者的管理提供科学依据。方法基于2010年建立的江苏省慢性HBV感染者队列，通过2012-2020年的6次随访，分析IHC发生乙肝再活动的流行病学特征以及超重、高血压、糖尿病、高血脂等代谢性疾病危险因素对乙肝再活动的影响。结果 2 527例IHC随访至2020年，共随访17 730人年，平均随访时间为7.0人年，共发生乙肝再活动98例，累积发生率3.9%，发病密度为5.53/1 000人年；多因素Cox比例风险回归分析结果显示，年龄、基线HBV DNA是IHC发生乙肝再活动的独立危险因素，与≥60岁年龄组相比，40~49岁组（aHR=2.16，95%CI：1.20~3.90）及20~29岁组（aHR=5.48，95%CI：2.07~14.48）发生乙肝再活动的风险显著升高；与基线时HBV DNA<100 IU/ml者相比，存在低病毒水平者（HBV DNA=100~1 999 IU/ml）发生乙肝再活动的风险显著升高（aHR=1.67，95%CI：1.11~2.52）；按照年龄分层分析结果显示，在≥50岁年龄组中，暴露于≥2个代谢性疾病危险因素者发生乙肝再活动的风险显著高于无代谢性疾病危险因素者（aHR=2.73，95%CI：1.08~6.96）。结论江苏省社区人群中IHC仍有发生乙肝再活动的风险，尤其是青壮年和低病毒活动水平的IHC；对于≥50岁且合并≥2个代谢性疾病危险因素的IHC，发生乙肝再活动的风险显著升高。对这部分人群应加强监测和管理，对于符合抗病毒治疗指征者应及时启动治疗，降低疾病进展的风险。

English Abstract:

Objective To analyze the impact of metabolic risk factors on the epidemiological characteristics of the reactivation of inactive HBsAg carriers (IHC) and provide effective intervention measures to standardize the management of chronic hepatitis B infections. Methods Based on the chronic hepatitis B infection cohort established in 2010 in Jiangsu province, six follow-up visits from 2012 to 2020 were conducted to analyze the characteristics and influencing factors of the hepatitis B reactivation of IHC and the impact of metabolic risk factors, including obesity, high blood pressure, diabetes and hyperglycemia. Results From 2012 to 2020, 2 527 IHC and 17 730 person-years were observed during a median follow-up period of 7.0 person-years. Ninety-eight cases of hepatitis B reactivation, with a cumulative reaction rate, was 3.9%, and the incidence density was 5.53/1 000 person-years. Multivariate Cox proportional risk regression analysis showed that age and baseline HBV DNA were independent risk factors of HBV reactivation. Compared with the patients ≥ 60 years, 40-49 age group (aHR=2.16, 95%CI:1.20-3.90) and 20-29 age group (aHR=5.48, 95%CI:2.07-14.48) were significantly associated with hepatitis B reactivation. Compared with the HBV DNA negative patients at baseline, the risk of hepatitis B reactivation was higher in the group with low HBV DNA level 100-1 999 IU/ml (aHR=1.67, 95%CI:1.11-2.52). Stratification analysis results showed that compared with those without metabolic risk factors, in the ≥ 50 age group, patients with ≥ 2 metabolic risk factors showed adjusted HR of 2.73 (95%CI:1.08-6.96). Conclusions The risk of hepatitis B being reactive is the persistent existence of IHC in communities in Jiangsu province, especially young adults, low-level HBV DNA carriers, and IHC with ≥ 2 metabolic risk factors. Follow-up for these IHC should be strengthened to reduce the risk of disease progression by antiviral treatment at the right time.

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