中国西南地区丁型肝炎的流行状况与临床特征分析

Prevalence and clinical characteristics of hepatitis D in Southwest of China

目的探讨丁型肝炎患者的流行状况及临床特征。方法筛查2010年1月1日至2020年12月31日陆军军医大学西南医院感染病研究所HBsAg阳性病例832144例,进行HDV-Ag和(或)HDV-IgG检测,共13585例。最终收集157例丁型肝炎患者的资料,年龄22~85(53±13)岁,其中男性122例,女性35例。对丁型肝炎的流行状况、临床特征及随访28天的转归、及其影响因素进行分析。结果近10年间,丁型肝炎筛查率仅1.6%(13585/832144),2011年筛查率最高,达4.13%(962/23289);筛查阳性率平均1.17%(157/13346),2012年筛查阳性率最高,达3.56%(58/1627)。病源分布:重庆66.24%(104/157)、四川22.93%(36/157)、贵州8.28%(13/157)、云南1.27%(2/157)、江西和西藏各0.64%(1/157)。病情程度:18.47%(29/157)慢性轻中度肝炎、23.57%(37/157)慢性重度肝炎、28.66%(45/157)慢加急性肝衰竭、27.39%(42/157)代偿或失代偿肝硬化、1.91%(3/157)原发性肝细胞癌。病情进展的发生率由高到低依次为:慢加急性肝衰竭48.89%(22/48)>原发性肝细胞癌33.33%(1/3)>肝硬化25.58%(11/43)>慢性重度肝炎18.92%(7/37)>慢性轻中度肝炎6.90%(2/29)(P<0.05)。其中,7.64%(12/157)合并肝性脑病;3.82%(6/157)合并其他病毒感染,包括HCV、EBV、CMV。Logistic回归分析,高龄、合并肝性脑病、高胆红素血症、凝血酶原时间延长是影响丁型肝炎患者转归的独立危险因素。结论近10年,丁肝的筛查率低,阳性率不高。HDV感染会加速肝炎进展,增加发生肝脏不良事件风险,值得重视。

Objective To study the prevalence and clinical characteristics of hepatitis D patients.Methods A total of 832144 HBsAg positive persons who were from infectious department of Southwest Hospital Affiliated to Army Military Medical University were screened from January 1,2010 to December 31,2020.A total of 13585 subjects completed relevant Hepatitis Delta virus(HDV)biomarker tests,157 HDV patients were evaluated.The mean age was 53±13 years,with a range of 22-85 years.The majority of these subjects were male.The prevalence,clinical characteristics,the outcome of 28 days follow-up and the influencing factors of the outcome were analyzed.Results In recent 10 years,the screening rate related to hepatitis D was only 1.6%(13585/832144),and the screening rate was the highest in 2011,up to 4.13%(962/23289);The positive rate of screening was only 1.17%(157/13346).In 2012,the positive rate of screening was the highest,up to 3.56%(58/1627).In Southwest Hospital,the source of disease was 66.24%(104/157)in Chongqing,22.93%(36/157)in Sichuan,8.28%(13/157)in Guizhou,1.27%(2/157)in Yunnan,and 0.64%(1/157)in each of Jiangxi and Tibet.Of 157 patients,29(18.47%)had non-cirrhotic with chronic low bilirubin hepatitis,23.57%(37/157)was non-cirrhotic with chronic high bilirubin hepatitis,28.66%(45/157)had acute-on-chronic liver failure(ACLF),27.39%(42/157)had compensated cirrhosis or decompensated cirrhosis,and 1.91%(3/157)had primary hepatocellular carcinoma.The incidence of disease progression was 48.89%(22/48)of chronic-on-acute liver failure>33.33%(1/3)of primary hepatocellular carcinoma>25.58%(11/43)of compensated or decompensated cirrhosis>18.92%(7/37)of non-cirrhotic with chronic high bilirubin hepatitis>6.90%(2/29)of non-cirrhotic with chronic low bilirubin hepatitis(P<0.05).Among them,7.64%(12/157)had hepatic encephalopathy,and the rate of disease progression was 83.33%(10/12)(P<0.05);3.82%(6/157)of them had combined with other hepatophilic viruses including hepatitis C virus(HCV),Epstein-barr virus,(EBV),Cytomegalovirus(CMV)infections.Logistic regression analysis showed that old age,complication with hepatic encephalopathy,hyperbilirubinemia and prolonged coagulation time were independent risk factors affecting the outcome of hepatitis D.Conclusions In recent 10 years,the screening rate of hepatitis D is low and the positive rate is not high.It should be noted that HDV infection can accelerate the progress of hepatitis and increase the risk of adverse liver outcomes.