Assessment on the Effects of Hepatitis B Prevention and Control Measures in Western China:A Comparison of Three Population-based Serosurveys

Objective Despite the remarkable progress in efforts to control disease spread,the nationwide elimination of hepatitis B in China is still hindered by the persistently high rate of hepatitis B virus(HBV)infection in Western China.This study aimed to evaluate the strategy of hepatitis B prevention and control in Western China and identify potential areas and strategies for improvement.Methods Susceptible population vaccination,health education,professional training of doctors,and other prevention and control measures have been implemented in Wuwei city since 2010.Data were obtained from three representative cross-sectional serosurveys conducted in 2010,2013,and 2015.The serum samples were subjected to enzyme-linked immunosorbent assays to detect the following seromarkers:HBV surface antigen(HBsAg),antibody against hepatitis B surface antigen(anti-HBs),and antibody against hepatitis B core antigen(anti-HBc).Estimates of variance were determined using Taylor series linearization methods.Results The three serosurveys revealed decreases in the prevalence of HBsAg(7.19% in 2010 vs.6.51% in 2013 vs.5.87% in 2015)and anti-HBc positivity(43.89%vs.32.87%vs.28.46%)and an increase in the prevalence of anti-HBs positivity(49.07%vs.53.66%vs.53.72%)over time.From 2010 to 2015,the legally reported incidence of hepatitis B in Wuwei city decreased from 686.53/100,000 to 53.72/100,000.Notably,persistently high HBsAg-positive rates(above 5.40%)were observed among subjects aged 20–69 years old in the three serosurveys;the prevalence of HBsAg was above 1% among children younger than 10 years old.Furthermore,rural subjects had higher rates of HBsAg and anti-HBc positivity than their urban counterparts(6.04%vs.4.83% and 30.26%vs.20.35%,respectively)in 2015 but had a lower rate of anti-HBs positivity(49.68 vs.55.18%).Multivariate regression analysis showed that age,urban and rural areas,and education level were the main factors affecting HBV infection.Conclusion Although vaccine-based prevention and control measures reduced the rate of HBV infection in Wuwei City over time,the hepatitis B infection rate in children younger than 10 years was still higher than the national average level.Therefore,the prevention and control of mother-to-child transmission and the management of the infected should be the focus of future prevention and control work.

H2 strain attenuated live hepatitis A vaccines:protective efficacy in a hepatitis A outbreak

AIM:To investigate the protective efficacy of H2 strain attenuated live hepatitis A vaccines (H2-strain vaccines) in hepatitis A (HA) outbreaks.METHODS:With the permission of their parents, 5551 pre-school and grade 1-3 primary school children were inoculated with 1 dose (10(6.5) TCID(50)) of H2 strain vaccines in a nonrandomized, controlled trial conducted in Fucheng County, Hebei Province in May 1997.Another 6485 children in the same grades and compatible in gender and age were enrolled as controls. Epidemiological and serological survey was conducted to evaluate the protective efficacy of the vaccines. ELISA was used to detect serum IgM anti-HAV.RESULTS:HA outbreak started in early May 1998, peaked in the middle of the same month, and lasted about 80 days. Overall 302 HA cases were found, 192(63.58%) were 5-9 years old. One vaccinee and 25 control cases were found to have hepatitis A, which account for 0.28% (1/356) and 5.92% (25/422) of all vaccinees and controls in the 14 villages, respectively. The protective efficacy of vaccines was 95.27% (95% CI: 85.83%-104.72%). In subjects tested for anti-HAV IgM from 13 villages, 1(0.40%) overt and 11(4.06%) asymptomatic HAV cases were found in 271 vaccinees but 21(6.69%) of overt and asymptomatic ones were found in 314 controls.CONCLUSION:H2 strain vaccines were excellent in preventing overt hepatitis A,but not so effective in preventing asymptomatic hepatitis A virus infection.A booster dose might be needed to get permanent reliable immunity.

Survey of coverage,strategy and cost of hepatitis B vaccination in rural and urban areas of China

AIM In order to understand the coverage, immunization strategy and cost of hepatitis B (HB) vaccination of China in recent years. METHODS A two stage household random sampling method was used in the survey. RESULTS The survey carried out at 112 Disease Surveillance Points (DSPs) of 25 provinces, autonomous regions and municipalities of China in 1996, showed that the coverage rates of HB vaccination among neonates were 96 9% in the urban DSPs and 50 8% in the rural DSPs in 1993-1994, while in students aged 7-9 years, they were 85 8% and 31 5% in 1994, respectively. Up to 1994, 97 5% of the urban DSPs and 73 9% of the rural DSPs on a neonate vaccination against HB program were included in EPI. About 93% of the urban DSPs and 44% of the rural DSPs did HBsAg and HBeAg screening for all or part of pregnant women. The neonates received the regimen of high dose HB vaccine in combination with hepatitis B immune globin (HBIG) if their mothers were HBsAg and/or HBeAg positive in pregnancy, otherwise they received the low dose vaccine (10μg×3). Part of DSPs had a lower neonate coverage due to unreasonable allocation of the vaccines (used for adults not at risk) or higher cost or insufficient supply of the vaccines. It is necessary to evaluate the quality of serological lab test to HBVMs in the maternal prescreening. CONCLUSION Remarkable achievements have been made according to the national planning and policy of HB immunization in China.

Evaluation and Risk Prevention and Control of Hepatic Injury by Traditional Drugs

My topic is the risk assessment of safety of Chinese materia medica.Next I will take drug-induced hepatic injury as an example.First of all,let us look back at what Chinese materia medica is.What are the real meanings of these 3 words? These 3 words Zi Hua Zi have been said more than BC 500."TCM practitioners are for treatment and medicines," what do you mean? Treatment means to find the cause of the disease and to find the law,while medicine is to find ways and means to cure diseases.

Preventing Alcohol Consumption during Pregnancy: A Randomized Controlled Trial

The aim of this study is to report on a brief alcohol intervention for preventing drinking during pregnancy. The Women’s Organizations Committee on Alcohol and Drug Issues (WOCAD) in Sweden developed an informational brochure about alcohol during pregnancy, intended to reach pregnant women before their first visit at a prenatal clinic. A randomized controlled trial was conducted between 2004 and 2005 to measure whether the brochure had any effect. A total of 564 pregnant women between 17 and 46 years of age are included in the study. Differences between the intervention and control groups were analyzed with cross-tabulations and chi-squared tests. A multiple logistic regression analysis was also conducted to determine predictors of abstention from alcohol at the first prenatal visit. Findings show that significantly more of the women who received the brochure abstained completely from alcohol then of those who did not receive it (92% vs. 82%, p = 0.005). It was 2.6 times more likely that those who received the brochure had abstained completely from alcohol since pregnancy recognition at their first prenatal visit compared with those who did not receive it (OR = 2.6, CI 1.3 - 5.1, p = 0.005). We conclude that the informational brochure developed by WOCAD can be used in prenatal care to get more women to abstain from alcohol during pregnancy.

2018—2022年漯河市丙型病毒性肝炎流行病学特征分析

目的:分析漯河市2018—2022年丙型病毒性肝炎流行趋势,为科学有效防控丙型病毒性肝炎提供参考。方法:丙型病毒性肝炎病例资料和人口资料来源于中国疾病预防控制信息管理系统,从系统中获取漯河市2018—2022年丙型病毒性肝炎病例报告资料及各年度人口资料进行统计分析。结果:2018—2022年,漯河市丙型病毒性肝炎报告发病率呈明显下降趋势,共报告发病病例4372例,年均发病率为34.39/10万;女性发病率高于男性,报告病例以45~70岁年龄段人群为主,报告病例职业以农民为主,无季节性发病特征;临颍县累计报告丙型病毒性肝炎病例最多,为2221例(50.80%),报告发病率也最高(65.37/10万)。结论:2018—2022年漯河市丙型病毒性肝炎流行特征具有地区、年龄、职业差异,应针对重点人群积极采取防治措施,从而消除丙型病毒性肝炎所产生的危害,切实保障居民的健康。

戊型肝炎病毒跨物种传播和防控技术研究进展

戊型肝炎病毒(Hepatitis E virus,HEV)是一种主要通过粪-口途径传播的人兽共患病病原,被认为是引起人类急性肝炎的主要原因之一。HEV可被分为8种基因型,各基因型的分布与地域和工业化水平有关,其中HEV-3与HEV-4具有人兽共患的传播能力,能造成人类和各种动物宿主的感染。除人类外,猪是HEV最常见的宿主,随着研究的深入,发现HEV的宿主呈现多样性,包括牛、羊、鹿、兔和骆驼等多种动物,且各动物宿主之间存在跨物种传播的可能。HEV的跨物种传播是在人类和动物宿主频繁交流的过程中,通过适应性进化而形成的,受到宿主细胞受体和细胞因子的特异性差异限制。HEV基因重组有利于适应宿主的新毒株出现,也可能促进新的传播途径,从而促进HEV跨物种传播。通过对HEV传播途径的研究发现,基因型不同,传播途径也有所差异,而食用携带HEV的动物产品,特别是未煮熟的动物产品是造成人类感染HEV-3和HEV-4的主要原因。此外,水源的污染、职业暴露、输血与器官移植同样是HEV的重要传播途径。针对各种潜在的传播途径,可采取相关的防控手段对HEV进行预防,包括对动物食品进行充分的加热以灭活HEV、对水源进行消毒和净化、做好职业防护和疫苗注射等。为更好地了解和掌握HEV的流行规律,各地应加强对HEV的监测,并制定相关的防控策略。笔者从HEV病原学、跨物种感染和防控技术等方面进行综述,以期促进人们对HEV跨物种传播的深入认识并为HEV的防控提供参考。

2013—2022年南通市通州区病毒性肝炎流行特征分析

目的分析南通市通州区2013年1月—2022年12月病毒性肝炎的流行特征,为区卫生行政部门制定针对性的防控策略和措施提供科学依据。方法采用描述性流行病学方法分析2013—2022年南通市通州区病毒性肝炎报告数据,率的比较采用χ^(2)检验,P<0.05为差异有统计学意义。结果2013—2022年南通市通州区报告病毒性肝炎2391例,年平均发病率为0.189‰,未见因病毒性肝炎死亡病例。报告病例中,男女性别比为1.89:1;40~64岁组报告发病例数最多,占报告病例总数的58.34%;职业分类以农民、家务及待业、工人、离退人员、干部职员为主;报告发病例数在春季略有增高,总体上季节性变化不甚明显;高发地区为兴仁镇、兴东街道和金沙街道。结论2013—2022年南通市通州区病毒性肝炎报告发病率总体上呈现缓慢上升的趋势,乙型肝炎较为明显。为保障人民群众的身体健康和生命安全,采取综合性防控策略和措施,加强对病毒性肝炎的防控。

超声瞬时弹性成像参数对乙型肝炎合并非酒精性脂肪肝患者肝纤维化评估效能的研究

目的 探讨超声瞬时弹性成像参数对乙型肝炎合并非酒精性脂肪肝(NAFLD)患者肝纤维化评估效能。方法 对2020年5月至2022年6月我院收治的110例乙型肝炎合并NAFLD患者的一般资料进行回顾性分析。患者均开展肝穿刺活组织检查,依据《非酒精性脂肪性肝病防治指南(2018更新版)》和Metavir纤维化评分将患者分为:F0-1组(42例)、F2-3组(45例)、F4组(23例)。检测其肝脏生物化学指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)、总胆固醇(TC)、甘油三酯(TG)水平],应用肝脏瞬时弹性扫描仪检测其肝硬度值(LSM)。应用Spearman分析LSM和肝纤维化程度的相关性,采用受试者工作特征(ROC)曲线评估LSM对乙型肝炎合并NAFLD患者不同肝纤维化程度的诊断效能。结果 3组在性别、体质指数(BMI)、ALT、AST、ALP、LSM水平方面比较差异有统计学意义(P<0.05);Spearman相关分析显示,LSM值与性别、BMI、ALT、AST呈正相关(r=0.105,r=0.162,r=0.184,r=0.167,P<0.05),且与ALP无明显相关性(r=0.019,P>0.05);ROC曲线分析结果显示,LSM诊断乙型肝炎合并NAFLD患者不同肝纤维化程度F0-1级、F2-3级、F4级的AUC依次为0.910、0.828、0.929;灵敏度和特异度分别为75.0%、91.3%,77.8%、78.3%,82.6%、84.4%;且截断值依次为6.28 kPa、6.98 kPa、10.45 kPa。结论 超声瞬时弹性成像参数评估乙型肝炎合并NAFLD患者肝纤维化程度方面具有良好的诊断效能,且具有较高的稳定性。

鸭病毒性肝炎的防控措施

鸭病毒性肝炎是一种严重影响鸭健康的疾病,当前该疾病在鸭养殖过程中呈现高发趋势,给养殖工作造成诸多困扰。该疾病容易在雏鸭中传播,一旦出现,还容易引起较高的病死率,因此需要通过加强饲养环境管理、饲喂管理、科学免疫以及疫病的早期监控和发病后的及时有效处置等方式,来加强防控,降低疫病高发可能对雏鸭健康造成的威胁。该文对鸭病毒性肝炎的防控工作进行分析和探究,详细阐述了鸭病毒性肝炎的防控措施。旨在通过探究,能为鸭养殖工作的进行起到一定参考作用。

CYP11B2 expression in HSCs and its effect on hepatic fibrogenesis

INTRODUCTIONIt has been reported that renin-angiotensin systemexists in tissue and aldosterone can be synthesizedin extra-adrenal tissue including heart,bloodvessels and brain.Recent studies have broughtrich evidences in favour of aldosterone as a strongstimulator of fibrogenesis and mitogenesis.

Alcohol and tobacco misuse: Reducing aerodigestive cancer risk

Significant concerns over the health,social and economic burdens of the two most common,and frequently co-misused drugs of abuse,alcohol and tobacco,has encouraged focused but separate health promotion and disease prevention policies.However,this separation of focus means that while individuals who present with alcohol-related problems are increasingly supported to attain and maintain abstinence from alcohol they are not routinely assisted to refrain from smoking.This is tragically inopportune as alcohol and tobacco have an established"synergistic"effect on aerodigestive cancer risk.Moreover,even when patients successfully tackle their alcohol problems they remain at increased risk for developing these cancers,especially if they continue to smoke.A case series is presented together with a discussion on how service provision for co-misuse could be improved to obviate aerodigestive cancer risk.Given the prevalence of alcohol and tobacco use in the United Kingdom,these observations may have far reaching implications for the individual,health provider(s)and wider society.

20世纪60年代传染性肝炎疫情防治的历史考察——以河南省郑州市为例

1950年代末传染性肝炎在中国开始大规模爆发,发病人数显著增加。20世纪60年代,传染性肝炎成为郑州市三大多发性急性传染病之一,病程长,传染性强,病死率高,严重危害了人民的身心健康,并影响了劳动生产。党和政府秉承对人民生命和健康的关怀,积极领导各条医疗卫生战线从容应对。根据郑州市的实际情况,针对性地采取了实地调查、宣传教育、切断传染途径、药品研发、提供福利保障等措施,切实维护了患者与医务工作人员的生命和健康权益。

体质量控制与非酒精性脂肪性肝病:来自中国人群的证据

基于中国人群的临床试验及队列研究数据,本文系统总结了体质量/体质量指数(body mass index,BMI)水平及其变化在非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)预防及其不良结局发生风险中的意义。结果显示,BMI与NAFLD发生风险呈显著正相关;对于已发生NAFLD的人群,其基线BMI水平与NAFLD缓解率呈负相关,与死亡或肿瘤等不良结局发生风险呈非线性相关;BMI正常的瘦型NAFLD人群全因死亡、肝脏相关死亡、消化系统肿瘤与肥胖相关肿瘤的发生风险较超重或肥胖型NAFLD、瘦型非NAFLD人群升高。NAFLD人群基线BMI水平与其不良结局的关联性可能受其他代谢指标的影响。控制基线BMI后,虽然多数研究提示体质量减轻可降低NAFLD发生风险,但由于不同研究对BMI变化的评估方法与评估时间窗不同,目前对于如何控制体质量进行NAFLD预防尚未达成一致结论。对于已发生NAFLD的人群,有限的证据显示减重对不同不良结局发生风险产生不同的影响。未来需开展多中心队列研究和试验性研究,充分考虑NAFLD的异质性,针对不同特征人群制订个体化体质量控制策略。

恩替卡韦治疗慢性乙型肝炎合并非酒精性脂肪性肝病患者疗效研究

目的探讨应用恩替卡韦治疗慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)患者的疗效。方法2019年6月~2021年8月我院收治的CHB患者63例和CHB合并NAFLD患者43例,给予两组恩替卡韦治疗12个月。采用肝脏弹性检测仪检测肝脏受控衰减参数(CAP),采用荧光定量聚合酶链式反应法检测血清HBV DNA载量,使用全自动生化分析仪检测血清丙氨酸氨基转移酶(ALT),采用化学发光法检测血清HBeAg,采用ELISA法检测血清反应性氧化物(ROS)、脂联素(ADPN)和肿瘤坏死因子-α(TNF-α)水平。结果在治疗6个月和12个月,CHB组血清ALT复常率分别为69.8%和92.1%,均显著高于CHB合并NAFLD组(分别为41.9%和74.4%,均P<0.05),而两组血清HBV DNA阴转率无显著性差异(分别为88.9%和98.4%对81.4%和93.0%,P>0.05);在治疗12个月,CHB组血清ALT为(41.9±6.5)U/L,显著低于CHB合并NAFLD组【(71.5±8.4)U/L,P<0.05】,肝脏CAP为(211.8±50.1)dB/m,显著低于CHB合并NAFLD组【(288.0±13.4)dB/m,P<0.05】;CHB组血清ROS和TNF-α水平分别为(403.6±70.2)U/mL和(15.5±5.6)ng/L,均显著低于CHB合并NAFLD组【分别为(628.7±67.5)U/mL和(31.7±6.0)ng/L,P<0.05】,而血清ADPN水平为(17.7±1.2)ng/mL,显著高于CHB合并NAFLD组【(11.5±1.8)ng/mL,P<0.05】。结论应用恩替卡韦治疗CHB合并NAFLD患者可能因为存在的肝脂肪变性而影响生化学应答,抗病毒治疗可能无法改变体内氧化应激状态,这是一个值得认真研究的问题。

乙型肝炎病毒表面抗原检查结果分析

目的 分析南阳镇1992—1994年与2020—2022年适龄应征青年乙型肝炎病毒表面抗原(HBsAg)检查结果,为乙型肝炎疾病防范提供参考借鉴。方法 选择福建省上杭县南阳镇1992—1994年冬季适龄应征男青年506名(对照组)与2020—2022年的每年冬、春季适龄应征男青年240名(观察组)作为研究对象。对照组HBsAg应用反向被动血凝试验(90°V型血凝板),观察组HBsAg采用酶联免疫夹心法。比较两组在HBsAg筛查阳性情况。结果 南阳镇在1992—1994年体检初筛人群筛查HBsAg阳性率变化不明显,差异无统计学意义(P> 0.05);2020—2022年体检初筛人群筛查HBsAg阳性率逐年降低,但组间差异无统计学意义(P> 0.05)。观察组3年间HBsAg阳性率明显低于对照组,差异有统计学意义(P <0.05)。结论 南阳镇2020—2022年适龄应征青年HBsAg筛查阳性率较1992—1994年明显降低,反映了我镇在乙型肝炎感染防治方面取得了重大成果。

乙肝疫苗接种预防控制婴幼儿乙肝感染的效果分析

目的探讨婴幼儿期接种乙型肝炎(乙肝)疫苗对预防控制乙肝感染的效果。方法138例完成乙肝疫苗全程三针接种的儿童,分别在疫苗接种1、2、3年后进行接种效果检测,观察接种1、2、3年后乙肝抗体滴度、乙肝病毒表面抗体(HBsAb)答应情况。结果接种1年后,乙肝抗体滴度(118.45±2.46)mU/ml高于接种2年后的(92.34±1.12)mU/ml,接种2年后乙肝抗体滴度高于接种3年后的(48.67±1.09)mU/ml,差异有统计学意义(P<0.05)。接种1年后HBsAb无应答率4.35%、HBsAb低应答率5.07%、HBsAb阳性率90.58%;接种2年后HBsAb无应答率1.45%、HBsAb低应答率8.70%、HBsAb阳性率89.86%;接种3年后HBsAb无应答率23.19%、HBsAb低应答率22.46%、HBsAb阳性率54.35%。接种1、2、3年后HBsAb应答情况比较差异有统计学意义(P<0.05)。结论乙肝感染的预防控制中乙肝疫苗接种在婴幼儿期具有显著效果,值得在临床中推广运用。

某二甲医院2019—2020年丙型病毒性肝炎流行特征分析

目的分析2019—2020年某二甲医院丙型病毒性肝炎(简称丙肝)的发病趋势和流行特征,为制定有效的防控措施提供科学依据。方法回顾2019—2020年某二甲医院收治的291例丙肝患者的临床资料,分析其流行病学特征。结果2020年,该院收治丙型病毒性肝炎患者(138例)较2019年(153例)有所下降;全年各月均有病例报告,未表现出明显的季节性分布特征。291例患者中,男性构成比为64.95%,职业分布以农、渔(船)民业为主(36.08%),主要来自农村(44.33%)。随着月收入、受教育程度的增加,丙肝患者构成比降低;41~60岁年龄段患者构成比(39.18%)、已婚或同居患者构成比(57.73%)均为同类别中最高。结论某医院收治的丙肝患者中农村中年男性的占比高,丙型肝炎防治工作需针对重点人群、重点地区进行宣传教育,根据不同的流行特征采取相应的防控措施。

醇基液体燃料安全防控和消防救援对策研究

本文通过对多起醇基液体燃料安全生产事故典型案例进行研究,分析了醇基液体燃料的危险特点和主要应用场所的危险特性,总结了当前生产生活中使用醇基液体燃料存在的突出问题和经验教训,从而针对醇基液体燃料的安全防控和消防救援工作,提出相关对策和建议。

豹皮樟总黄酮对大鼠酒精性脂肪性肝炎的防治作用及部分机制

目的探讨豹皮樟总黄酮(TFLC)对大鼠酒精性脂肪性肝炎的防治作用及部分机制。方法以酒精联合脂肪乳剂灌胃,每天2次,连续6周,制备大鼠酒精性脂肪性肝炎模型。给药组同时灌服相应药物。于实验的第6周末采血,检测血清丙氨酸氨基转移酶(ALT)、天门冬氨基转移酶(AST)、γ-谷氨酰基转移酶(γ-GT)、碱性磷酸酶(ALP)、总胆固醇(TC)、甘油三酯(TG)、超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)及肝脏TG、TC、SOD、MDA、GSH-PX,并行肝脏病理学检查。结果TFLC(200、400mg/kg)组能明显降低酒精性脂肪性肝炎大鼠血清AST、ALT、ALP、γ-GT水平;降低血清和肝匀浆中TC、TG、MDA含量,增强SOD和GSH-PX活性;同时病理组织学显示TFLC能明显改善酒精性脂肪性肝炎大鼠的肝细胞脂肪变性。结论TFLC对大鼠酒精性脂肪性肝炎具有较好的防治作用。其作用机制与抗氧化和调节脂质代谢有关。