上海市2014-2019年丙型肝炎综合监测分析

Analysis of integrated HCV surveillance in Shanghai,2014-2019

目的分析上海市丙型肝炎(丙肝)综合监测数据,为上海市制定消除丙肝公共健康危害策略提供科学依据。方法利用2014-2019年上海市丙肝多维监测结果构建上海市丙肝综合监测系统并进行统计学分析,监测内容包括病例监测、病原学监测、行为危险因素监测、社区健康人群和高风险/重点人群监测等。采用描述性统计和logistic多因素回归模型进行统计分析。结果2014-2019年上海市急性丙肝年均报告发病率为0.18/10万,慢性丙肝年均报告发病率为8.60/10万。HCV基因分型成功744例,检测到HCV的GT1、GT2、GT3、GT6型4个型别16个亚型,其中1b型(324例,占43.55%)、3a型(121例,占16.26%)、3b型(111例,占14.92%)和6a型(47例,占6.32%)是上海市流行的主要型别;1b型的构成比有下降趋势,3b和6a型呈上升趋势。HCV感染的影响因素包括输血(OR=4.18,95%CI:2.79~6.27)、有手术史(OR=1.63,95%CI:1.26~2.12)和注射史(OR=4.18,95%CI:2.75~6.34)、修脚(OR=2.01,95%CI:1.54~2.62)、共用剃须刀(OR=4.09,95%CI:1.24~13.51)和曾在非正规医疗机构进行损伤性美容项目(OR=3.15,95%CI:2.13~4.65)等。11类丙肝高风险/重点人群65660人次的HCV抗体筛查结果显示,吸毒人群HCV抗体阳性率最高(占18.81%,1008/5358),社区健康人群HCV抗体阳性率为0.16%(7/4268),低于同年高风险/重点人群的2.50%(501/20002)(χ2=94.04,P<0.01)。结论2014-2019年上海市丙肝呈低流行。应持续开展丙肝综合监测,对于早期发现HCV感染者及其危险因素,完善丙肝防控策略有重要意义。

Objective The purpose of this study is to analyze the surveillance data of the Integrated HCV surveillance in Shanghai and provide a scientific basis for HCV's elimination strategies.Methods Descriptive statistical analysis and multivariate logistic regression analysis were performed using the multi-dimension results of the Integrated HCV surveillance in Shanghai from 2014 to 2019.Data related to reported HCV cases,HCV gene subtypes surveillance,HCV behavioral risk factors surveillance and HCV-antibody testing results of the community-based general population and high-risk/key populations.Results The reported incidence rate of acute hepatitis C in Shanghai decreased from 2014 to 2019(Z=-4.07,P<0.01);meanwhile,the reported incidence rate of chronic hepatitis C met an upward trend(Z=10.26,P<0.01),with an annual average,reported incidence rates of 0.18 per 100000 and 8.60 per 100000,respectively.Seven hundred forty-four blood samples were subtyped with 16 subtypes from 4 genotypes(GT1,GT2,GT3,and GT6).Among above,1b(324 cases,43.55%),3a(121 cases,16.26%),3b(111 cases,14.92%)and 6a(47 cases,6.32%)were the principal subtypes.The composition of genotypes varied with decreased 1b and increased 3b and 6a.The major risk factors for HCV infection were blood transfusion(OR=4.18,95%CI:2.79-6.27),surgery(OR=1.63,95%CI:1.26-2.12),sharing syringe(OR=4.18,95%CI:2.75-6.34),pedicure(OR=2.01,95%CI:1.54-2.62),sharing razors(OR=4.09,95%CI:1.24-13.51),and unsafe beauty practices(OR=3.15,95%CI:2.13-4.65).HCV antibody screening of 11 groups of high-risk/key populations showed that drug users had the highest HCV-antibody positive rate of 18.81%(1008/5358).The anti-HCV positive rate of the general population was 0.16%(7/4268),which was significantly lower than that of high-risk/key populations from the same year,2.50%(501/20002)(χ2=94.04,P<0.01).Conclusions Shanghai is a low-endemic area of HCV.Constantly carrying out integrated surveillance and analysis is of great value for early identification of HCV infected people and its risk factors,timely adjustment of prevention and control strategies,and eliminating the public health threat of HCV.