玉树地区藏族HBV感染家庭聚集性及影响因素分析

Analysis on Family Agglomeration and Influencing Factors for Tibetan HBV Infection in Yushu Region

目的:调查青海玉树地区藏族乙肝病毒(HBV)感染家庭聚集情况及影响因素,为制定乙肝防控措施提供依据。方法:收集2016年6月—2017年12月玉树地区乙肝血清调查中发现,共同生活家庭成员乙肝表面抗原(HBsAg)阳性人员169户为观察对象,进行问卷调查和血清实验室检测所有患者乙肝五项和ALT、AST、HBV-DNA。结果:①收集169户HBsAg阳性家庭资料,其中70户有家庭聚集性,99户无家庭聚集性,家庭聚集性为41.42%(70/169);②有、无乙肝家庭聚集性病例两组HBsAg阳性人员的年龄以(20~50)岁为主,两组病例在年龄构成、职业构成上比较,差异有统计学意义(P<0.001);③乙肝家族聚集病例HBeAg阳性率高于无乙肝家族聚集病例HBeAg阳性率,两组比较差异有统计学意义(P<0.05),HBeAg阳性是乙肝家族聚集高危因素(OR=4.555),两组HBeAg比较,差异有统计学意义(P<0.05),HBeAb是乙肝家族聚集保护因素(OR=0.030),两组HBeAb比较,差异无统计学意义(P>0.05)。HBV-DNA高低分布与乙肝家族聚集病例分布有关,随着HBV-DNA水平升高,乙肝聚集危险因素增加(OR=2.543、6.942)。肝脏生化指标ALT、AST升高在有、无乙肝聚集病例比较,差异有统计学意义(P<0.05),ALT、AST升高是乙肝聚集的高危因素(OR=4.982、4.252)。结论:低年龄组、儿童、HBeAg和HBV-DNA阳性、ALT及AST升高是乙肝家庭聚集的危险因素,玉树地区乙肝家庭聚集性明显,需加强家庭内部传播的防护。

Objective:This study is aimed to understand the infection status of hepatitis B virus(HBV)in Tibetan population in Yushu,the family gathering status of HBV infection and the distribution so as to provide scientific basis for the formulation of HBV prevention and control in ethnic minority areas.Methods:The family members who are found to be living together with HBsAg positive in the serum survey of hepatitis B in Yushu from 2016 to 2017 were selected as the objects,conducting questionnaires and serum laboratory tests(including hepatitis B five and ALT,AST,HBV-DNA).Results:① According to the household registration certificate and self-report,data of 169 HBsAg positive families were collected,among which 70 households had family aggregation,and 99 households had no family aggregation,which was 41.42%;② The age of HBsAg positive patients in the two groups was mainly between 20 to 50 years old,with statistically significant differences in age composition and occupational composition between the two groups(P < 0.001);③ There was a statistical difference between the two groups(P < 0.05),and HBeAg positive was a risk factor for hepatitis B family cluster(OR=4.555).The high and low distribution of HBV-DNA was related to the distribution of hepatitis B family aggregation cases,and the risk factors of hepatitis B aggregation increased with the rise of HBV-DNA level(OR=2.543、6.942).Thus,the elevated ALT and AST were risk factors for hepatitis B aggregation(OR=4.982、4.252).Conclusion:High family aggregation rate of hepatitis B in Yushu,contributes to the HBeAg,HBVDNA positive and increased ALT and AST among low age group,children and students.