江苏省1~69岁人群乙型肝炎血清标志物组合模式及HBV病毒载量分析

Analysis of combination modes of HBV serological markers and HBV viral loads among population aged 1-69 years in Jiangsu province

目的了解江苏省1~69岁人群乙型肝炎血清标志物组合模式,并对组合模式与乙型肝炎病毒(Hepatitis B Virus,HBV)病毒载量进行相关分析。方法采取多阶段随机抽样方法,抽取2020年江苏省6个国家监测点1~69岁常住人口进行HBV血清流行病学调查。采用酶联免疫吸附法和化学发光微粒子免疫法法,对乙肝表面抗原(HBsAg)、乙肝表面抗体(抗-HBs)、乙肝e抗原(HBeAg)、乙肝e抗体(抗-HBe)、乙肝核心抗体(抗-HBc)进行定性和定量检测,对HBsAg阳性者血清进行荧光定量PCR检测。结果共调查4502人,检出8种乙型肝炎血清标志物组合模式,其中模式9(未感染)检出率最高(占42.00%),其次是模式8(仅抗-HBs阳性,占33.56%);1~4岁组以单一抗-HBs阳性的模式8检出最高(77.29%);5~69岁组以全阴性的模式9为主(44.26%)。模式8以有免疫史人群为主(占63.53%),且在有免疫史人群中构成比随年龄的增长呈下降趋势(χ^(2)_(趋势)=82.39,P<0.05)。HBsAg阳性人群的模式1(大三阳)与模式2(小三阳)HBV病毒载量M(P_(25),P_(75))分别为2.8×10^(8)(975.0,8.5×10^(8))、268.3(43.8,1.3×10^(3))IU/ml,差异有统计学意义(Z=-3.84,P<0.05);2组HBV病毒载量主要为高水平复制(占66.67%)和低水平复制(占33.36%),HBV高病毒载量与HBeAg水平呈正相关(r=0.87,P<0.01)。结论江苏省乙肝防制工作取得显著成绩,但仍存在一定的免疫空白,需加强免疫。5岁以下人群以人工免疫为主,成年人群以人工免疫和自然感染相结合的方式为主;HBeAg水平与HBV DNA病毒载量密切相关。

Objective To determine combination modes of HBV serological markers among population aged 1-69 years in Jiangsu province;to analyze the correlation between combination modes of HBV serological markers and HBV viral loads.Methods Local residents aged 1-69 years were sampled from 6 national disease surveillance sites by multi-stage random sampling method in Jiangsu province in 2020.Serum samples were detected qualitatively and quantitatively for HBsAg,Anti-HBs,HBeAg,Anti-HBe and Anti-HBc by enzyme linked immunosorbent assay(ELISA)and chemiluminescent microparticle immunoassay(CMIA),respectively.The HBsAg positive serum samples were detected by fluorescence quantitative PCR.Results A total of 4502 subjects were investigated and 8 combinations of HBV serological markers were detected.Mode 9(uninfected)had the highest detection rate(42.00%),followed by mode 8(Anti-HBs postive only,33.56%).The mode 8 was mainly detected in 1-4 year age group(77.29%),and the negative mode 9 were dominant in 5-69 year age group(44.26%).The model 8 were detected mainly among immunized subjects,the proportion demonstrated descending trend upon age(χ^(2)_(trend)=82.39,P<0.05).The M(P_(25),P_(75))of HBV viral loads were 2.8×10(975.0,8.5×10^(8))IU/ml and 268.3(43.8,1.3×10^(3))IU/ml in mode 1 and mode 2 among HBsAg positive subjects,with statistical significance(Z=-3.84,P<0.05).HBV viral loads in two groups were mainly high level replication(66.67%)and low level replication(33.36%),respectively.There was a positive correlation between HBV high viral load and HBeAg(r=0.87,P<0.01).Conclusion Significant achievements have been made in the prevention and control of hepatitis B in Jiangsu province;however there are still some gaps in immunization,which need to be strengthened.The population<5 years old mainly adopts artificial immunity,while the adult population mainly adopts the combination of artificial immunity and natural infection.The HBeAg is closely related to HBV viral load.