摘要
Background:Universal vaccination for hepatitis B virus(HBV)and migratory movements have changed the demographic characteristics of this disease in Spain and in Europe.Therefore,we evaluated the characteristics of the disease and the possible differences according to origin(immigrants vs non-immigrants)and access to treatment.Methods:This is a multicenter cross-sectional study(June 2014 to May 2015)in which outpatients with a positive HBsAg were seen and followed in four Hepatology units.Demographic and clinical data and indication and access to treatment were collected in two different regions of Catalonia(Spain)where there are no barriers to treatment due to a comprehensive coverage under the National Health System.Results:A total of 951 patients were evaluated(48.1%men).Of these,46.6%were immigrants(58.7%of them were born in Africa)and were significantly younger compared to non-immigrants.The proportions of patients with alcohol consumption,being overweight,and other indicators of metabolic co-morbidities were significantly higher in non-immigrants.Among the 937 patients receiving HBeAg examination,91.7%were HBeAg-negative.Chronic HBeAg-positive infection was significantly higher in immigrants(3.9%vs 0.6%,P=0.001)and chronic HBeAg-negative hepatitis was higher non-immigrants(31.7%vs 21.4%,P<0.001).Not only was the proportion of patients who met treatment criteria significantly higher among nonimmigrants(38.4%vs 29.2%,P=0.003),but also the proportion of those with indication of effectively receiving therapy at the time of data collection(83.2%vs 57.8%,P<0.001).Conclusions:The immigrant population with HBV is younger and has a lower prevalence of metabolic co-morbidities and a higher frequency of chronic HBeAg infection.Despite having access to care and an indication for treatment,some do not get adequately treated due to several factors including local adaptation that precludes access to treatment.
背景:乙肝疫苗的广泛接种和外部移民的不断增多已经改变了西班牙乃至整个欧洲乙型肝炎的流行病学数据。因此,本研究旨在评估乙型肝炎的人口统计学特征,并探讨不同来源(移民与非移民)和治疗路径患者间可能存在的差异。方法:这是一项多中心横断面研究(2014年6月至2015年5月),研究对象来自四个肝病中心收治和随访的HBsAg阳性门诊患者。收集西班牙加泰罗尼亚两个地区(国家卫生系统全面覆盖、无任何治疗障碍的地区)患者人口统计学特征、临床资料、治疗适应证及获治情况。结果:共对951例患者进行评估,其中男性占48.1%。46.6%为移民(其中87.7%出生于非洲),其较非移民更为年轻。在非移民患者中,酗酒、体重过重以及合并其他代谢性疾病者的比例相对较高。在937例接受HBeAg检测者中,91.7%为阴性。慢性HBeAg阳性肝炎在移民患者中的比例更高(3.9%vs 0.6%,P=0.001),但慢性HBeAg阴性肝炎则在非移民患者中的比例更高(31.7%vs 21.4%,P<0.001)。无论是满足治疗标准需要治疗的比例(38.4%vs 29.2%,P=0.003),还是需要治疗者中实际接受了治疗的比例(83.2%vs 57.8%,P<0.001),非移民患者均高于移民者。结论:相较于非移民,移民乙肝患者年龄相对较轻,代谢性合并症患病率较高,慢性HBeAg感染更为多见。尽管可以获得治疗且具有治疗指征,但部分移民者由于局部适应等问题并没有得到充分的治疗。
