启东乙肝疫苗干预研究随访人群中慢性乙肝、肝硬化患病的危险因素分析

Risk factors of chronic hepatitis B and liver cirrhosis: a cross-sectional study based on Qidong hepatitis B intervention study

目的 探索启东乙型肝炎疫苗（以下简称乙肝疫苗）干预研究人群患慢性乙型肝炎（以下简称慢乙肝）、肝硬化的危险因素。方法 采用分层随机抽样方法,于2013年1月~10月,在启东乙肝疫苗干预研究随访人群中抽取研究对象进行面对面问卷调查,调查内容包括人口社会学资料、个人及家族成员慢乙肝、肝硬化及肝癌史等;同时进行谷丙转氨酶（alanine aminotransferase,ALT）、乙型肝炎病毒（hepatitis B virus,HBV）感染血清学标志物检测及肝脏彩色超声检查。使用多因素Logistic回归分析乙肝疫苗干预研究随访人群罹患慢乙肝、肝硬化的危险因素。结果 疫苗组慢性乙型肝炎及肝硬化患病率均低于对照组;慢性乙型肝炎患者中男性、有肝癌家族史、新生儿期未接种乙肝疫苗和出生于1986年以前四个因素,调整后的OR（95%CI）值分别为：3.60（2.04~6.34）、2.47（1.25~4.88）、2.68（1.57~4.56）和1.72（1.02~2.89）。肝硬化患者中男性因素,调整后的OR（95%CI）值为6.89（2.02~23.43）。结论 启东新生儿接种乙肝疫苗能降低青年期罹患慢乙肝、肝硬化的风险,男性、肝癌家族史及出生于1986以前为慢性乙型肝炎的危险因素,男性亦为肝硬化的危险因素。

Objective To explore the risk factors of chronic hepatitis B and liver cirrhosis in the participants from Qidong Hepatitis B intervention Study. Methods From January to October, 2013, by using a cross-sectional study de- sign, all the participants from Qidong Hepatitis B intervention Study were sampled by a stratified random method. Question- naire survey was conducted to gain their sociodemographic information and family history of liver cancer. Blood tests for A1- anine aminotransferase （ALT）, hepatitis B virus surface antigen （HBsAg）, anti-HBs, anti-HBc, hepatitis B virus e anti- gen （ HBeAg）, anti-HBe, and ultrasonic examination of liver were implemented in every sampled subject. Multivariate Lo- gistic regression analyses were conducted to explore the risk factors of chronic hepatitis B and liver cirrhosis. Results The prevalence rate of chronic hepatitis B and liver cirrhosis of vaccination group was significantly lower than that of control group. Multivariate Logistic regression showed that male, liver cancer family history, no neonatal vaccination and born be- fore 1986 in patients with chronic hepatitis B, the adjusted OR （95% CI） were 3. 60（2. 04-6. 34）, 2. 47（1.25-4. 88）, 2. 68（ 1.57-4. 56）, 1.72（ 1.02-2. 89）, respectively. Male factors in patients with liver cirrhosis, the adjusted OR （95% CI） was 6. 89 （2.02-23.43）. Conclusions Neonatal hepatitis B vaccination could protect inoculated population from chronic liver diseases. Male, liver cancer family history, no neonatal vaccination, born before 1986 were risk factors of chronic hepatitis B and male was also a risk factor of liver cirrhosis.