上海市松江区就诊人群丙型肝炎病毒感染的流行病学调查

Epidemiology of hepatitis C virus infection in patients in Songjiang District, Shanghai

目的了解上海市松江区就诊人群HCV感染现状,并分析丙型肝炎患者进展为肝纤维化的危险因素。方法在松江区区域临床检验中心的实验室信息系统(LIS)中回顾性收集2015—2017年就诊的HCV感染人群相关信息,包括性别、年龄、HCV抗体、HCV RNA、ALT、AST、TBil,计算AST血小板比率(APRI)及纤维化-4(FIB-4),并进行比较分析。结果上海市松江区2015—2017年分别有18 419例、18 809例及37 306例患者接受过HCV抗体检测,HCV抗体阳性率分别为0.77%、0.73%及0.53%。224例接受了HCV RNA检测的患者中有106例(47.32%)HCV RNA阳性。男性患者的ALT、AST及TBil指标异常率明显高于女性患者(χ^2=16.793、12.072、6.815,P<0.01)。41~50岁年龄组患者ALT指标异常率为43.12%,高于其他年龄组(χ^2=18.392,P<0.01)。APRI、FIB-4分级与HCV RNA(χ^2=55.507、12.439,P<0.01),以及年龄(χ^2=18.546、149.575,P<0.05或<0.01)有关,随着年龄的增加,APRI及FIB-4分级2、3级占比有升高趋势。APRI分级与性别有关(χ^2=12.925,P<0.01)。结论上海市松江区就诊人群HCV感染率在男性、41~50岁人群中较高。HCV RNA阳性及年龄(>60岁)可能是丙型肝炎患者进展为肝纤维化的危险因素。

Objective To explore the HCV infection status among the patients in Songjiang District, Shanghai, and analyze the risk factors for hepatic fibrosis among HCV patients. Methods Consecutive HCV-related data from 2015 to 2017 in the Laboratory Information System (LIS) of Songjiang Regional Clinical Testing Center were retrospectively collected, including gender, age, HCV antibody, HCV RNA, ALT, AST and TBil. AST platelet ratio (APRI) and fibrosis-4 (FIB-4) were calculated and compared. Results A total of 18 419, 18 809 and 37 306 patients in 2015, 2016 and 2017 tested HCV-antibody were enrolled in the study. The anti-HCV positive rate was 0.77%, 0.73% and 0.53%, respectively. Among 224 anti-HCV positive patients, 106 patients (47.32%) were HCV RNA positive. The abnormal rates of ALT, AST and TBil in male patients were significantly higher than those in female patients (χ^2=16.793, 12.072, 6.815, P<0.01). The abnormal rate of ALT index in 41-50 years old group was 43.12%, which was higher than that in other age groups (χ^2=18.392, P< 0.01). APRI and FIB-4 were related to positive HCV RNA (χ^2=55.507, 12.439, P both<0.01) and age (χ^2=18.546, 149.575, P<0.05 or 0.01). The proportions of APRI and FIB-4 grade 2 and 3 increased with age. APRI was related to gender (χ^2=12.925, P<0.01). Conclusions In Songjiang District, anti-HCV positive rate is high in male patients or 41-50 years old patients. HCV RNA positive and age (>60 years old) may be related to significant fibrosis among HCV patients.