血液透析患者乙肝病毒感染情况及影响因素分析

Prevalence rates and influencing factors of hepatitis B virus infection in maintenance hemodialysis patients

目的调查2016年6月至2017年6月四川省人民医院血液透析中心维持性血液透析(MHD)患者乙型肝炎病毒(HBV)感染情况及相关影响因素,为透析持续质量改进提供数据支持。方法对MHD患者(>3个月)进行包括乙肝表面抗原(HBsAg)、表面抗体(抗HBs)、e抗原(HBeAg)、e抗体(抗HBe)及核心抗体(抗HBc)检测,并按性别、年龄等因素进行分层分析。结果(1)共326例MHD患者,男女比1.26∶1,本中心HBsAg阳性率为7.67%,HBV感染率为62.27%;(2)将MHD患者按年龄分为20～29岁、30～39岁、40～49岁、50～59岁、60～69岁、70～79岁、≥80岁,HBV感染率分别为0%、42.86%、66.07%、49.15%、64.89%、67.16%、88.00%;(3)将MHD患者分为<60岁中青年组和≥60岁老年组,发现老年组HBV感染率(68.82%)明显高于中青年组53.57%(P <0.05);(4)将MHD患者分为HBV感染者(203例)和非HBV感染者(123例),发现HBV感染组男性(60.59%)明显高于女性(39.41%)(P <0.05);HBV感染组乙肝疫苗接种率(31.03%)明显低于非HBV感染组(48.78%)(P <0.05)。结论四川省人民医院血液透析中心HBsAg阳性率7.67%,HBV感染率62.27%,老年患者、男性患者HBV感染率高,乙肝疫苗能有效降低HBV感染率,故应重视MHD患者乙肝疫苗接种普及,特别是老年男性患者,以降低MHD患者的HBV感染率。

Objective To investigate the prevalence rates of hepatitis B virus(HBV)and influencing factors of the infection among maintenance hemodialysis(MHD)patients in Sichuan Province from June 2016 to June 2017 for the sake of contributing data support to the implementation of continuous quality improvement of hemodialysis.Methods Maintenance haemodialysis patients(duration of dialysis>3months)at Sichuan Provincical People’s Hospital dialysis units from June 2016 to June 2017 were enrolled.hepatitis B surface antigen(HBsAg),hepatitis B surface antibody(anti-HBs),hepatitis Be antigen(HBeAg)hepatitis B core antigen(HBcAg),hepatitis B core antibody(anti-HBc),were examined by ELISA.Stratified analyses based on gender,age and other factors are conducted.Results(1)Three hundred and twenty six MHD patients(age from 27~95)with a mean age of 60.40±14.20 years were enrolled in this study,Older patients over 60 years of age account for 57.06%,55.83% were male and 44.17% were female(males:females=1.26∶1);(2)In our hemodialysis units,the positive rate of HBV surface antigen was 7.67%(25/326);The infection rate of HBV was 62.27%(203/326).(3)We divided the 326 MHD patients into 7groups:20~29years of age,30~39years of age,40~49years of age,50~59years of age,60~69years of age,70~79years of age,≥80years of age,The infection rate of HBV were 0%(0/4),42.86%(9/21),66.07%(37/56),49.15%(29/59),64.89%(61/94),67.16%(45/67),88%(22/25)respectively,and The infection rate of HBV was the highest in the 80 years age group;(4)We divided the 326 MHD patients into young-middle age group(<60years of age)and elderly group(≥60years of age),The infection rate of HBV in elderly group is significantly higher than young-middle age group(P <0.05);(5)The 326 MHD patients were divided into HBV infected group and non-HBV infected group.In the HBV infected group the number of male(60.59%,123/203)is significantly higher than female(39.41%,80/203),which indicated the genda difference.Meanwhile,the rate of HBV vaccination in HBV infected group is significantly lower than non-HBV infected group which indicate HBV vaccine can reduce the infection rate of HBV.Conclusion The positive rate of HBV surface antigen was 7.67% and The infection rate of HBV was 62.27%in Sichuan Provincical People’s Hospital hemodialysis units.The infection rate of HBV is higher in elder,male MHD patients.HBV vaccination can effectively reduce the infection rate of HBV.This data indicates that we should pay attention to the prevalence of HBV vaccination,especially in the elder male patients for reducing the infection rate of HBV in MHD patients.