启东乙型肝炎干预研究：2013年随访人群HBV感染及慢性肝病现患调查

Long-term efficacy of neonatal hepatitis B vaccination against chronic hepatitis B virus infection and chronic liver disease： a cross-sectional study based on Qidong Hepatitis B Intervention Study

目的分析新生儿接种乙型肝炎（乙肝）疫苗人群在达到婚配年龄后罹患慢性乙肝、肝硬化的远期保护作用。方法2013年1—10月采用横断面调查方法，对启东乙肝干预研究（QHBIS）的研究对象分层随机抽样，并行ALT、HBV感染血清学标志物（HBsAg、HBeAg、抗-HBs、抗-HBc、抗-HBe）检测及肝胆B超检查。计算HBV感染血清学标志物各指标的阳性率，慢性乙肝及肝硬化的患病率，疫苗组及对照组人群按性别分层后，疋。检验比较各组间率的差异。结果共获得新生儿乙肝疫苗接种组（疫苗组）4421人和对照组3880人，平均年龄分别为（25．59±1．84）岁和（26．61±2．24）岁。疫苗组HBsAg、单独抗一HBs、抗一HBc、HBeAg、抗一HBe阳性率分别为2．38％、37．73％、3．78％、0．57％、2．15％，对照组分别为9．02％、29．41％、16．83％、2．73％、8．87％，两组问血清学标志物各指标的差异均有统计学意义（P〈0．05）。疫苗组慢性乙肝活动期、肝纤维化及肝硬化患病率分别为0．45％和0．16％，对照组分别为1．29％和0．39％，组间差异均有统计学意义（P〈0．05）。按性别分层后，疫苗组男性慢性乙肝活动期患病率高于女性，差异有统计学意义（P〈0．05）；在对照组，不管是慢性乙肝活动期患病率还是肝纤维化及肝硬化患病率，男性均高于女性，差异有统计学意义（P〈0．05）。结论新生儿接种乙肝疫苗对慢性HBV感染的保护作用可延长至婚配年龄后，而不同性别人群慢性乙肝与肝硬化现患保护作用的差异值得进一步研究。

Objective To evaluate the long-term protection efficacy of neonatal hepatitis B vaccination on chronic hepatitis B （CHB） and liver fibrosis and cirrhosis in adults. Methods From January to October, 2013, a cross-sectional study was conducted among the participants from Qidong Hepatitis B Intervention Study （QHBIS）, who were selected through stratified random sampling. The detections of serum alanine aminotransferase （ALT）, HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe were conducted and ultrasonography on liver, gallbladder and spleen was performed for them. The positive rates of each serologic markers, the prevalence of active CHB and liver fibrosis and cirrhosis were calculated, the gender specific differences between vaccination group and control group were compared with Chi-square test. Results A total of 4 421 participants aged （25.59 ±1.84） years in vaccination group and 3 880 participants aged （26.61 ± 2.24） years in control group were surveyed. The positive rates of HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were 2,38%, 37,73%, 3,78%, 0.57% and 2.15% in vaccination group, and 9.02%, 29.41%, 16.83%, 2.73% and 8.87% in control group, respectively, the differences between two groups were statistically significant （all P〈0.05）. The prevalence of active CHB and liver fibrosis and cirrhosis were 0.45% and 0.16% in vaccination group, 1.29% and 0.39% in control group, the differences between two groups were statistically significant （P〈0.05）. The active CHB prevalence was lower in females than in males in both vaccination group and control group （P〈0.05）. The liver fibrosis and cirrhosis prevalence was lower in females than in males in control group （P〈0.05）; whereas, no statistical significant difference in liver fibrosis ＆ cirrhosis prevalence between males and females was found in vaccination group （P〉 0.05）. Conclusions Protection conferred by neonatal hepatitis B vaccination could last to marrying age. The gender specific difference in protection efficacy needs further study.