25730例乙型肝炎病毒感染患者血清学模式回顾分析

A Retrospective Analysis of Serological Patterns in 25730 Patients with Hepatitis B Virus Infection

目的总结25730例乙型肝炎病毒感染患者血清学标志物模式。方法回顾性分析2018~2021年乙型肝炎病毒(hepatitis B virus,HBV)感染患者中血清学模式、比例及合并感染情况。收集北京佑安医院2018~2021年HBV感染患者的乙肝五项(HBsAg、Anti-HBs、HBeAg、Anti-HBe、Anti-HBc)、肝功能、HBV DNA载量、AFP和PT检测结果及基本临床信息,采用SPSS 26.0统计学软件分析HBV感染患者的疾病诊断、乙肝五项血清学标志物阳性模式和临床特征情况。结果2018~2021年就诊患者HBsAg阳性率依次为63.80%、61.37%、58.44%和53.16%,呈逐年下降趋势,组间两两比较差异均有统计学意义(P<0.001)。25730例患者按照年龄分为1~30岁组、31~60岁组和>60岁组,3个年龄组急性乙型肝炎、慢性乙型肝炎、HBV相关性肝硬化、HBV相关性肝癌及肝癌术后、肝移植术后临床诊断差异均有统计学意义(均P<0.05)。随着年龄增长,慢乙肝的患者比例呈下降趋势(χ^(2)=2390.617,P<0.001);而HBV相关性肝硬化、HBV相关性肝癌及肝癌术后和肝移植术后的HBV感染患者随着年龄增长,患者比例呈上升趋势(χ^(2)=1390.946,P<0.001;χ^(2)=586.225,P<0.001;χ^(2)=22.647,P<0.001)。乙肝五项血清模式有20种,其中常见模式有9种(比例最高为145阳)、少见模式5种(比例最高为5阳),罕见模式6种(比例最高为235阳)。HBV感染中丙肝抗体阳性率为2.658%(312/11740),HIV确证阳性率为0.158%(16/10113),抗核抗体阳性率为68.483%(4663/6809)。结论2018~2021年,全院就诊患者HBsAg阳性检出率逐年下降。HBV感染患者疾病进展与患者年龄相关。HBV感染者乙肝五项血清学指标模式呈现多样性,结合HBV DNA结果和合并感染有助于对特殊模式的理解。

Objective To summarize serum marker patterns of approximately 25730 patients with hepatitis B virus infection.Methods We analyzed serological patterns,proportions,and co-infections of hepatitis B virus infected patients from 2018 to 2021 by a retrospective analysis.The five markers of hepatitis B,(HBsAg,Anti-HBs,HBeAg,Anti-HBe and Anti-HBc),liver function test,HBV DNA load,AFP and PT test results and basic clinical information of HBV infected patients in Beijing You’an Hospital from 2018 to 2021 were collected.SPSS26.0 statistical software was used to analyze the disease diagnosis,the patterns of five serological indicators of hepatitis B and clinical characteristics of HBV infected patients.Results The positive rates of HBsAg in patients from 2018 to 2021 were 63.80%,61.37%,58.44%and 53.16%,respectively.The trend was decreasing yearly,and there were statistically significant differences between the two groups(P<0.001).Patients were divided into 1-30,31-60 and>60 years old groups according to their age ranges.There were statistically significant differences in clinical diagnosis among the three groups of acute hepatitis B(AHB),chronic hepatitis B(CHB),HBV-related liver cirrhosis,HBV-related liver cancer,liver cancer after surgery and liver transplantation,respectively(all P<0.05).With the increase of age,the proportion of CHB showed a downward trend(χ^(2)=2390.617,P<0.001).The proportion of HBV infected patients with HBV-related liver cirrhosis,HBV-related liver cancer,liver cancer surgery,and liver transplantation increased with age(χ^(2)=1390.946,P<0.001;χ^(2)=586.225,P<0.001;χ^(2)=22.647,P<0.001).There were 20 serum patterns of the five markers of hepatitis B,including 9 common patterns(the main pattern is 145 positive),5 rare patterns(the main pattern is 5 positive)and 6 rare patterns(the main pattern is 235 positive).The positive rate of hepatitis C antibody in HBV infected patients was 2.658%(312/11740).And syphilis antibody positive rate was 1.523%(151/9917).The confirmed positive rate of HIV was 0.158%(16/10113).Anti-nuclear antibody positive rate was 68.483%(4663/6809).Conclusion The HBsAg positive detection rate from 2018 to 2021 has been decreasing yearly.Age is related to the disease progression of HBV infected patients,which is consistent with the trajectory of disease development.The patterns of the five serological indicators of hepatitis B in HBV infected patients are diversified.Combining HBV DNA results with co infection can help us understand specific patterns.