血液透析患者HBV感染影响因素的多水平模型分析

苏通; 李春霞; 王君; 陈卿; 冯永亮; 石璟; 王素萍; 梁晓峰

Abstract

苏通,李春霞,王君,陈卿,冯永亮,石璟,王素萍,梁晓峰.血液透析患者HBV感染影响因素的多水平模型分析[J].Chinese journal of Epidemiology,2015,36(5):510-514

血液透析患者HBV感染影响因素的多水平模型分析

Study on risk factors of hepatitis B virus infection among patients receiving hemodialysis by multi-level statistical model analysis

Received:November 15, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.05.021

KeyWord: 血液透析乙型肝炎病毒感染多水平模型

English Key Word: Hemodialysis Hepatitis B virus infection Multi-level analysis model

FundProject:国家科技重大专项(2012ZX10002001-003-004); 山西医科大学博士启动基金(03201109); 山西省回国留学人员科研资助(2013-056)

Author Name	Affiliation	E-mail
Su Tong	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
Li Chunxia	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
Wang Jun	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
Chen Qing	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
Feng Yongliang	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
Shi Jing	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
Wang Suping	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China	spwang88@163.com
Liang Xiaofeng	Chinese Center for Disease Control and Prevention

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Abstract:

目的了解维持性血液透析(MHD)患者HBV感染现状, 并探讨相关影响因素。方法 2012年11月至2014年12月对山西省范围内16所医院血液透析中心1 524名MHD患者进行问卷调查, 收集研究对象一般人口学特征及可能的HBV感染危险因素等, 检测乙型肝炎(乙肝)血清学标志物5项。用SAS 9.3软件拟合两水平logistic回归模型分析HBV感染影响因素。结果1 524名MHD患者的HBsAg阳性率为5.25%, HBV感染率为38.85%, 不同医院之间感染率不同(t=2.33, P=0.034)。拟合两水平logistic回归零模型分析得到组内相关系数(ICC)=0.106 4, 约10.64%的总变异是由医院不同引起。引入解释变量后的结果显示, MHD患者50～65岁组的HBV感染率高于0～35岁组(OR=1.560, 95%CI:1.061～2.293);有拔牙史(OR=1.267, 95%CI:1.009～1.591)和乙肝家族史(OR=2.052, 95%CI:1.176～3.582)是HBV感染的危险因素;乙肝疫苗接种是HBV感染的保护因素(OR=0.734, 95%CI:0.541～0.996)。结论不同医院间MHD患者HBV感染存在差异, 年龄组(50～65岁)、乙肝家族史及拔牙史为MHD患者HBV感染危险因素, 接种乙肝疫苗为保护因素。

English Abstract:

Objective To understand the current status of HBV infection among patients receiving maintenance hemodialysis (MHD) and related influencing factors. Methods A questionnaire survey was conducted among 1 524 MHD patients selected from hemodialysis units in 16 hospitals in Shanxi province from 1 November 2012 to 30 December 2014 to collect their demographic information and learn about their risk behaviors. Serological detection was conducted for them. Statistical software package SAS 9.3 was used for fitting a two level logistic regression model to identify the independent risk factors for HBV infection. Results Among the 1 524 MHD patients, the positive rate of HBsAg was 5.25% and the HBV infection rate was 38.85%. The HBV infection rate varied with hospital (t=2.33, P=0.034). The two-level logistic regression empty model showed that intra-class correlation coefficient was 0.106 4, indicating that about 10.64% of the total variation was caused by the differences in hospitals. After introducing explaining variables, the results showed that the HBV infection rate in age group 50-65 years group was higher than that in age group 0-35 years (OR=1.560, 95%CI:1.061-2.293). Family history of HBV infection and dental surgery were the risk factors for HBV infection (OR=2.052 and 1.267, 95%CI:1.176-3.582 and 1.009-1.591). Receiving HepB vaccination was a protective factor for HBV infection (OR=0.734, 95%CI:0.541-0.996).Conclusion The HBV infection rates were different among MHD patients in different hospitals. Old age(50-65 years), family history of HBV infection and dental surgery were the risk factors and receiving HepB vaccination was a protective factor for HBV infection among MHD patients.

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