渝东南片区家族聚集性乙型肝炎患者的调查研究

Investigation on patients with familial aggregation of hepatitis B in southeast district of Chongqing

目的分析渝东南片区家族性乙型病毒性肝炎发病情况,为减少或阻断家族性乙型肝炎的传播,防治家族聚集性乙型肝炎提供对策。方法选择110例家族性乙型肝炎患者,总计其家族成员共有295例HbsAg阳性成员,按男性及女性、已婚及未婚进行分组,调查家族直系三代乙型肝炎病毒感染情况,区分母婴之间、父婴之间的传播,分析乙型肝炎疫苗接种情况,分析家族中肝硬化、肝癌的发病情况,死亡病例调查死亡原因,统计男女发病的差异性。结果 110例乙型肝炎患者配偶感染的概率男性为22.2%,女性为20.5%,二者差异无统计学意义(P>0.05)。而母辈阳性的其子女感染率达到(66.7%以上),明显高于父辈阳性的子女感染率(≤11.1%),二者差异有统计学意义(P<0.05)。该区成年家族聚集性乙型肝炎患者普遍乙型肝炎疫苗接种率较低(≤23.2%),乙型肝炎免疫球蛋白的使用就更低(2.7%)。295例HbsAg阳性成员肝硬化的发病率为8.5%,原发性肝癌(HCC)发病率为4.4%,因肝病死亡19例(16个家庭),110例乙型肝炎患者39例(35.4%)进行规范化乙型肝炎抗病毒治疗。结论母婴传播是家族聚集性乙型肝炎感染的主要原因,父婴传播、密切的生活接触仍可以导致乙型肝炎感染,该区家族聚集性乙型肝炎感染高发病与乙型肝炎疫苗的接种率、乙型肝炎免疫球蛋白的使用率低有关。未规范化乙型肝炎抗病毒治疗,是导致家族聚集性乙型肝炎并发肝硬化或HCC高发的主要原因。

Objective To investigate the incidence of familial hepatitis B viral （HBV） infection in the southeast part of Chongqing,and provide information for its prevention and treatment. Methods 295 patients with HbsAg positive came from 110 families were selected and divided to different groups by gender and marital status. We investigated the infections of HBV in three generations of the immediate families. This research focused on the difference between mother-to-child transmission and father-to- child transmission, the status of receiving HBV vaccine, the morbidity and mortality of cirrhosis and hepatic carcinoma, the cause of death,and the impact of gender in three generations. Results Of the 110 cases,the HBsAg positive rate for children with HBsAg positive mothers （more than 66.7%） was significantly higher than that with positive father （less than 1.1%）,while there was no significant difference between male spouses and female spouses （22.2 %versus 20.5 %, P〉0.05）. Only 23.2 % received HBV vac- cine and 2.7% got immune globulin of HBV. 8.5% of the 295 persons had cirrhosis and 4.40% of them had primary hepatocellular carcinoma （HCC） ;19 patients from 16 families died of liver diseases. 39 cases of 110 patients got antiviral treatment regularly. Con- clusion As well as father-to-child transmission and close contact,mother-to-child transmission contributed to familial HBV infec- tion,and even more common. The high rate of familial HBV infection in this area was associated with low rate of vaccination and immune globulin of HBV. The leading cause of the high incidence of hepatocellular carcinoma and hepatic cirrhosis was substandard treatment.