江苏省部分地区人群丙型肝炎病毒感染状况及危险因素研究

Rate of infection and related risk factors on hepatitis C virus in three counties of Jiangsu province

目的 调查江苏省一般人群HCV抗体的阳性率分布,分析感染HCV的危险因素.方法 在江苏省3个地区的传染病防制示范区以乡镇和行政村为单位随机整群抽样,进行问卷调查和血清HCV抗体检测,利用SPSS软件分析抗体阳性率在不同人群中的分布差异,Cox模型拟合1：4配对的logistic回归分析HCV感染危险因素.结果 HCV感染情况在不同人群分布有差异,女性感染率（0.965％,95％CI：0.899％～1.035％）高于男性（0.572％,95％CI：0.517％ ～ 0.632％）;3个县人群感染率（分别为0.131％,95％CI：0.103％ ～ 0.164％;0.316％,95％CI：0.268％ ～ 0.370％;2.173％,95％CI：2.039％ ～ 2.315％）的差异有统计学意义;50～ 59岁年龄组感染率最高（1.577％,95％CI：1.425％～ 1.740％）,＜30岁年龄组最低（0.161％,95％CI：0.125％ ～ 0.204％）;受教育程度越低感染率越高,其中流动人口感染率高.危险因素分析显示,感染率最低的地区多因素分析显示住院史（OR=3.049,95％CI：1.322～ 7.036）、输血史（OR=14.319,95％CI：2.318 ～ 88.459）和共用剃刀（OR=3.604,95％CI：1.096～ 11.851）是HCV感染的独有危险因素;感染率较低的地区分析显示仅血制品使用史（OR=7.202,95％CI：1.170～ 44.310）是独有危险因素;感染率最高的地区显示献血史（OR=7.496,95％CI：6.121～ 9.180）、输血史（OR=2.305,95％CI：1.578～ 3.369）和侵入性检查史（OR=1.258,95％CI：1.021 ～ 1.549）为独立危险因素.不同年龄组单因素分析显示,30～39岁组与他人共用剃刀是独有危险因素,50 ～ 59岁组有针灸史是该年龄组危险因素,50～59岁和60～ 69岁组有侵入性检查是危险因素.结论 HCV感染在中老年人、教育程度低、流动性强的人群中感染率高,不安全献（输）血、血制品使用可能是既往几十年中HCV感染的主要危险因素;针灸、侵入性检查以及共用剃刀等在不同人群中的危险度有差异.

Objective To investigate the hepatitis C virus （HCV） infection rate among general population in Jiangsu province and to analyze the main risk factors for HCV infection.Methods Subjects in 3 counties were surveyed by stratified cluster random sampling in the National Major Science and Technology Projects demonstration area in Jiangsu province.Interview was carried out with uniformly-designed questionnaires.Blood samples were collected and anti-HCV tested.Data were analysed under SPSS 13.0.Case-control study was conducted on two groups with subjects under 1：4 matching by sex,age,village of residence and status of HCV infection.Cox＆#39; s proportional hazards regression analysis was then performed to analyze the risk factors for HCV infection.Results The positive rate of anti-HCV was higher in females （0.965%,95%CI：0.899%-1.035%） than in males （0.572%,95%CI：0.517%-0.632%）.Significant differences were noticed among the positive rates of anti-HCV in the three counties （0.131%,95%CI：0.103%-0.164% ; 0.316%,95%CI：0.268%-0.370% ; 2.173%,95% CI：2.039%-2.315%,respectively）.Peak prevalence of anti-HCV （1.577%,95%CI：1.425%-1.740%） was observed among persons at 50-59 years of age.Bottom rate （0.161%,95%CI：0.125%-0.204%） was observed below 30 years of age.High anti-HCV positive rate was detected in people with lower education background or belonged to ‘floating population’.Factors as having histories of hospitalization （OR=3.049,95% CI：1.322-7.036）,blood transfusion （OR=14.319,95%CI：2.318-88.459） or sharing razor （OR=3.604,95%CI：1.096-11.851） were risk factors of HCV infection in the area with the lowest anti-HCV positive rate.In another county,factor as having histories of ‘blood products transfusion’ （OR=7.202,95% CI：1.170-44.310） appeared important while in the third county,having history of ‘blood donation’ （OR=7.496,95%CI：6.121-9.180） ; ‘blood transfusion’ （OR=2.305,95%CI：1.578-3.369） and ‘invasive physical examination’ （OR=1.258,95% CI：1.021-1.549） appeared to be important.Age seemed a risk factor for HCV infection.＆quot;Sharing razor＆quot; was a specifically important risk factor among the 30-year-olds.＆quot;Having received acupuncture＆quot; was noticed a risk factor only among people at 50-59 years of age while ＆quot;Having received invasive physical examination＆quot; was important in the 50-59 and 60-69 year-olds.Conclusion High anti-HCV positive rate was observed in people at middle of aged population,as well as in those with poor education or under ‘floating’.Unsafe blood donation or having received blood-product transfusion might be the risk factors in the last decades.Factors as sharing razor,having received acupuncture or invasive examination might be specifically risky in different populations.