Long-term follow-up of cumulative incidence of hepatocellular carcinoma in hepatitis B virus patients without antiviral therapy

BACKGROUND China has a high prevalence of hepatitis B virus(HBV),but most chronic hepatitis B(CHB)patients do not receive standardized antiviral therapy.There are few relevant reports addressing the outcomes of the large number of CHB patients who do not receive antiviral therapy.AIM To observe the outcomes of long-term follow-up of patients with CHB without antiviral treatment.METHODS This study included 362 patients with CHB and 96 with hepatitis B cirrhosis without antiviral treatment and with only liver protection and anti-inflammatory treatment from 1993 to 1998.The median follow-up times were 10 and 7 years,respectively.A total of 203 CHB and 129 hepatitis B cirrhosis patients receiving antiviral therapy were selected as the control groups.The median follow-up times were 8 and 7 years,respectively.Kaplan-Meier curves were used to analyze the cumulative incidence of hepatocellular carcinoma(HCC),and the Cox regression model was used to analyze the risk factors for HCC.RESULTS Among the patients in the non-antiviral group,16.9%had spontaneous decreases(HBeAg)seroconversion.In the antiviral group,87.2%of patients had undetectable HBV DNA,and 52%showed HBeAg seroconversion.Among CHB and hepatitis B cirrhosis patients,the cumulative incidence rates of HCC were 14.9%and 53.1%,respectively,in the non-antiviral group and were 10.7%and 31.9%,respectively,in the antiviral group.There was no difference between the two groups regarding the CHB patients(P=0.842),but there was a difference between the groups regarding the hepatitis B cirrhosis patients(P=0.026).The cumulative incidence rates of HCC were 1.6%and 22.3%(P=0.022)in the groups with and without spontaneous HBeAg seroconversion,respectively.The incidence rates of HCC among patients with and without spontaneous declines in HBV DNA to undetectable levels were 1.6%and 19.1%,respectively(P=0.051).There was no difference in the cumulative incidence of HCC between the two groups regarding the patients with drug-resistant CHB(P=0.119),but there was a significant difference between the two groups regarding the patients with cirrhosis(P=0.004).The Cox regression model was used for regression of the corrected REACH-B score,which showed that alanine aminotransferase>400 U/L,history of diabetes,and family history of liver cancer were risk factors for HCC among men aged>40 years(P<0.05).Multifactorial analysis showed that a family history of HCC among men was a risk factor for HCC.CONCLUSION Antiviral therapy and non-antiviral therapy with liver protection and antiinflammatory therapy can reduce the risk of HCC.Antiviral therapy may mask the spontaneous serological response of some patients during CHB.Therefore,the effect of early antiviral therapy on reducing the incidence of HCC cannot be overestimated.

Implication of Reported Viral Hepatitis Incidence Rate Change in Hubei Province, China, between 2004-2010

This study examined the change of reported incidence rate for viral hepatitis in Hubei province, China, between 2004 to 2010 to provide scientific evidence for viral hepatitis control. Reported viral hepatitis infection cases were queried from Centre for Disease Control of Hubei Province, China. The incidence of viral hepatitis A decreased steadily across the study period. Viral hepatitis B composed 85% of the viral hepatitis cases. When reported incidence rates for chronic hepatitis B increased, the rates of acute and unclassified cases dropped from 2005 to 2010. The reported viral hepatitis B incidence rate for males was around 1.5-2 times higher than for females. The average annual percentage change of reported viral hepatitis B incidence rates was 4%. The same index for viral hepatitis C was 28%. The reported viral hepatitis B incidence rate of people under 20 years old declined over the period. This decrease was mainly attributed to the recent implementation of vaccination plan. Reported incidence rate of viral hepatitis E also rose in those years. Having a better understanding on reported incidence rates of the present surveillance system is important for developing strategies for further prevention of viral hepatitis. In addition, the data showed that a surveillance system that differentiates new and former infected cases will be more effective in providing evidence for disease control.

Analysis of the Incidence of Hepatitis B and Hepatitis C and Association with Socio-Economic Factors in Various Regions in China

The incidence of liver cancer in China accounts for more than half of the world, and the majority of them is caused by hepatitis B and hepatitis C. China is known as a great contributor to hepatitis. The Chinese government has implemented a series of preventive measures to solve this problem, especially the policy of free hepatitis B vaccination for newborn babies and effectively reduced the incidence of hepatitis. The incidence of infectious diseases is often related to socio-economic factors. Therefore, we used data on the incidence of hepatitis B and C and socioeconomic factors to analyze and find out the relationship among them in various regions. There were high incidence areas and low incidence areas in China, and the high incidence area of hepatitis B was also the high incidence area of hepatitis C. Especially in Xinjiang, the highest incidence of hepatitis B and hepatitis C was observed at the same time. The incidence of hepatitis B and hepatitis C was more affected by regional economic factors. The economic factors in low incidence areas of hepatitis were better than those in high incidence areas. There was a negative correlation between economic factors and the incidence of hepatitis. In conclusion, in economically developed areas, the government has invested more money and resources in public health and people’s health awareness in comparison to underdeveloped areas. In the future, various preventive strategies should be carried out according to the background of different regions.

Incidence and prevalence of hepatitis B and hepatitis C viruses in hemodialysis patients in Lebanon

AIM: To determine the incidence and the prevalence of hepatitis B and C viral infections in patients on hemodialysis(HD) across Lebanon.METHODS: We reviewed the data registry at the Lebanese Ministry of Public Health where records of monthly hepatitis B surface antigen(HBs Ag) and hepatitis C virus(HCV) serology are reported from 60 affiliated HD centers across Lebanon. All patients who were on HD or who started HD between October 2010 and July 2012 were included in the study. Patients from seven HD centers were excluded due to inadequate and incomplete results reporting. During the selected period, HBs Ag and HCV serology were available for 3769 patients from 53 HD centers distributed at all Lebanese governorates. The prevalence was calculated by dividing the number of patients with positive HBs Ag or HCV serology to the total number of patients. The Incidence was calculated by dividing the number of newly acquired infection to number of patients-years(p-y). Incidence rates at different governorates were compared to each other using two tailed Z test and a P value of < 0.05 was considered significant.RESULTS: Sixty out of 3769 HD patients were found to have positive HBS Ag and 177 out of 3769 were positive for HCV Antibodies. The prevalence of hepatitis B virus(HBV) and HCV in HD patients across Lebanon was 1.6%, and 4.7%, respectively. The comparison of prevalence according to geographic distribution could not be done accurately due to the frequent shift of patients between dialysis centers at different governorates. The incidence rate was 0.27 per 100 p-y for HBV and 0.37 per 100 p-y for HCV. There was no significant difference concerning the incidence of HBV between HD centers at different governorates(all P values > 0.1), but this difference was highly significant concerning the incidence rates of HCV which occurred predominantly in the southern centers(1.47 per 100 p-y) with a P value of 0.00068 and 0.00374 when compared to Mount Lebanon(0.21 per 100 p-y) and the Northern centers(0.19 per 100 p-y), respectively.CONCLUSION: The incidence rate of HBV and HCV is very low in the Lebanese HD centers and their prevalence is decreasing over the last two decades.

Prediction and prophylaxis of hepatocellular carcinoma occurrence and postoperative recurrence in chronic hepatitis B virus-infected subjects

Hepatocellular carcinoma(HCC) is one of the most common and highly fatal malignancies worldwide. Chronic infection with hepatitis B virus(HBV) is a major cause of HCC. High HBV replication rate and related non-resolving inflammation are the major risk factors of HCC occurrence and postoperative recurrence. Early prophylactic options are effective in reducing HCC occurrence and improving survival. Therefore, it is important to identify HBV-infected patients who are at a higher risk of developing HCC and HBV-HCC patients who are more likely to relapse after surgery, thus providing them with more precise prophylactic strategies. Several prediction models of HCC occurrence have been constructed, with satisfactory predictive accuracy and discriminatory ability. However, there is a lack of consensus for their clinical implementation. Several staging systems have been proposed for HCC prognosis. However, the accuracy of these staging systems based on demographic characteristics and clinical measurements needs to be further improved, possibly by systematically incorporating viral and inflammatory factors. Since antiviral treatments are effective in promoting liver function reserve, reducing HCC occurrence and prolonging postoperative survival in some HBV-infected subjects, it is very important to identify subgroups of HBV-infected patients who would most benefit from antiviral treatment.

Systematic overview of hepatitis C infection in the Middle East and North Africa

AIM To assess the quality of and to critically synthesize the available data on hepatitis C infections in the Middle East and North Africa(MENA) region to map evidence gaps.METHODS We conducted an overview of systematic reviews(SRs) following an a priori developed protocol(CRD42017076736). Our overview followed the preferred reporting items for systematic reviews and metaanalyses guidelines for reporting SRs and abstracts and did not receive any funding. Two independent reviewers systematically searched MEDLINE and conducted a multistage screening of the identified articles. Out of 5758 identified articles, 37 SRs of hepatitis C virus(HCV) infection in populations living in 20 countries in the MENA region published between 2008 and 2016 were included in our overview. The nine primary outcomes of interest were HCV antibody(anti-) prevalences and incidences in different at-risk populations; the HCV viremic(RNA positive) rate in HCV-positive individuals; HCV viremic prevalence in the general population(GP); the prevalence of HCV co-infection with the hepatitis B virus, human immunodeficiency virus, or schistosomiasis; the HCV genotype/subtype distribution; and the risk factors for HCV transmission. The conflicts of interest declared by the authors of the SRs were also extracted. Good quality outcomes reported by the SRs were defined as having the population, outcome, study time and setting defined as recommended by the PICOTS framework and a sample size > 100.RESULTS We included SRs reporting HCV outcomes with different levels of quality and precision. A substantial proportion of them synthesized data from mixed populations at differing levels of risk for acquiring HCV or at different HCV infection stages(recent and prior HCV transmissions). They also synthesized the data over long periods of time(e.g., two decades). Anti-HCV prevalence in the GP varied widely in the MENA region from 0.1%(study dates not reported) in the United Arab Emirates to 2.1%-13.5%(2003-2006) in Pakistan and 14.7%(2008) in Egypt. Data were not identified for Bahrain, Jordan, or Palestine. Good quality estimates of anti-HCV prevalence in the GP were reported for Algeria, Djibouti, Egypt, Iraq, Morocco, Pakistan, Syria, Sudan, Tunisia, and Yemen. Anti-HCV incidence estimates in the GP were reported only for Egypt(0.8-6.8 per 1000 person-year, 1997-2003). In Egypt, Morocco, and the United Arab Emirates, viremic rates in anti-HCV-positive individuals from the GP were approximately 70%. In the GP, the viremic prevalence varied from 0.7%(2011) in Saudi Arabia to 5.8%(2007-2008) in Pakistan and 10.0%(2008) in Egypt. Anti-HCV prevalence was lower in blood donors than in the GP, ranging from 0.2%(1992-1993) in Algeria to 1.7%(2005) in Yemen. The reporting quality of the outcomes in blood donors was good in the MENA countries, except in Qatar where no time framework was reported for the outcome. Some countries had anti-HCV prevalence estimates for children, transfused patients, contacts of HCV-infected patients, prisoners, sex workers, and men who have sex with men.CONCLUSION A substantial proportion of the reported outcomes may not help policymakers to develop micro-elimination strategies with precise HCV infection prevention and treatment programs in the region, as nowcasting HCV epidemiology using these data is potentially difficult. In addition to providing accurate information on HCV epidemiology, outcomes should also demonstrate practical and clinical significance and relevance. Based on the available data, most countries in the region have low to moderate anti-HCV prevalence. To achieve HCV elimination by 2030, up-to-date, good quality data on HCV epidemiology are required for the GP and key populations such as people who inject drugs and men who have sex with men.

Hepatitis C virus infection in Argentina: Burden of chronic disease

AIM: To estimate the progression of the hepatitis C virus(HCV) epidemic and measure the burden of HCVrelated morbidity and mortality. METHODS: Age- and gender-defined cohorts were used to follow the viremic population in Argentina and estimate HCV incidence, prevalence, hepatic complications, and mortality. The relative impact of two scenarios on HCV-related outcomes was assessed:(1) increased sustained virologic response(SVR); and(2) increased SVR and treatment.RESULTS: Under scenario 1, SVR raised to 85%-95% in 2016. Compared to the base case scenario, there was a 0.3% reduction in prevalent cases and liverrelated deaths by 2030. Given low treatment rates, cases of hepatocellular carcinoma and decompensated cirrhosis decreased < 1%, in contrast to the base case in 2030. Under scenario 2, the same increases in SVR were modeled, with gradual increases in the annual diagnosed and treated populations. This scenario decreased prevalent infections 45%, liver-related deaths 55%, liver cancer cases 60%, and decompensated cirrhosis 55%, as compared to the base case by 2030. CONCLUSION: In Argentina, cases of end stage liver disease and liver-related deaths due to HCV are still growing, while its prevalence is decreasing. Increasing in SVR rates is not enough, and increasing in the number of patients diagnosed and candidates for treatment is needed to reduce the HCV disease burden. Based on this scenario, strategies to increase diagnosis and treatment uptake must be developed to reduce HCV burden in Argentina.

Epidemiological Study of Hepatitis A in Plovdiv Region—Bulgaria, 2005-2008

Background: Hepatitis A is a social disease and has great importance for public health in countries with high level of incidence rate. The problem is particularly serious for Bulgaria because the morbidity rate in the country is several times higher in comparison with the other countries of the European Union. The aim of the study is to establish the contemporary epidemiological characteristics of viral hepatitis A in Bulgaria. Methods: Analysis of the incidence rate and the age distribution has been done among two groups of the population differentiated depending on their hygienic living conditions: 1st group—living in bad hygienic conditions;2nd group—living in good hygienic conditions. A large epidemic outbreak of hepatitis A with 1004 persons of Roma origin has been described. The comprehensive method for epidemiological research and serological methods for determining the diagnosis have been used. To study the risk factors the methods of case-control and multi-factor logistic regression are used. Results: Nine times higher incidence rate has been established in the 1st group 450/100,000 in comparison with the 2nd 50/100,000. The patients from the 1st group are predominantly children aged 5 - 9 years and from the 2nd adults aged 30 - 39 years. The level of significance of the risk factors for the biggest epidemic outbreak has been established—bad personal hygiene is of the greatest importance. The risk for travellers to countries and regions with high endemicity and during epidemic outbreaks has been shown. Conclusions: There are essential differences in the epidemiology of HAV between the groups with different hygienic living conditions. That is why the analyses of the incidence rate and age distribution of hepatitis A have to be done separately for different population groups. Recommendations for providing differentiated measures for prevention and control of hepatitis A among the two groups are given.

Epidemiology of hepatitis C virus infection

Globally, hepatitis C virus (HCV) has infected an estimated 130 million people, most of whom are chronically infected. HCV-infected people serve as a reservoir for transmission to others and are at risk for developing chronic liver disease, cirrhosis, and primary hepatocellular carcinoma (HCC). It has been estimated that HCV accounts for 27% of cirrhosis and 25% of HCC worldwide. HCV infection has likely been endemic in many populations for centuries. However, the wave of increased HCV-related morbidity and mortality that we are now facing is the result of an unprecedented increase in the spread of HCV during the 20th century. Two 20th century events appear to be responsible for this increase; the widespread availability of injectable therapies and the illicit use of injectable drugs.

Hepatocellular carcinoma,human immunodeficiency virus and viral hepatitis in the HAART era

The incidence of hepatocellular carcinoma(HCC)in patients with human immunodeficiency virus(HIV) is rising.HCC in HIV almost invariably occurs in the context of hepatitis C virus(HCV)or hepatitis B virus (HBV)co-infection and,on account of shared modes of transmission,this occurs in more than 33% and 10% of patients with HIV worldwide respectively.It has yet to be clearly established whether HIV directly accelerates HCC pathogenesis or whether the rising incidence is an epiphenomenon of the highly active antiretroviral therapy(HAART)era,wherein the increased longevity of patients with HIV allows long-term complications of viral hepatitis and cirrhosis to develop.Answering this question will have implications for HCC surveillance and the timing of HCV/HBV therapy,which in HIV co-infection presents unique challenges.Once HCC develops,there is growing evidence that HIV co-infection should not preclude conventional therapeutic strategies,including liver transplantation.

A shield against a monster:Hepatitis C in hemodialysis patients

Hepatitis C virus(HCV)infection is highly prevalent among patients on hemodialysis(HD).The prevalence of HCV infection in HD patients varies markedly from country to country.Some factors are especially related to these high prevalence rates,such as blood transfusions and length of dialysis time. Nosocomial routes of transmission including the use of contaminated equipment and patient-to-patient exposure is considered more important.Several prophylactic measures have been suggested to avoid infection by HCV in the HD environment.

Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

AIM To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis. METHODS We used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality. RESULTS We identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years(range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients(71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death(OR = 5.39, 95%CI: 1.85-15.71).CONCLUSION Severe hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

Comparison of time trends in the incidence of primary liver cancer between China and the United States: an age-period-cohort analysis of the Global Burden of Disease 2019

Background::China and the United States(US)ranked first and third in terms of new liver cancer cases and deaths globally in 2020.Therefore,a comprehensive assessment of trends in the incidence of primary liver cancer with four major etiological factors between China and the US during the past 30 years with age-period-cohort(APC)analyses is warranted.Methods::Data were obtained from the Global Burden of Disease 2019,and period/cohort relative risks were estimated by APC modeling from 1990 to 2019.Results::In 2019,there were 211,000 new liver cancer cases in China and 28,000 in the US,accounting for 39.4%and 5.2%of global liver cancer cases,respectively.For China,the age-standardized incidence rate(ASIR)consecutively decreased before 2005 but increased slightly since then,whereas the ASIR continuously increased in the US.Among the four etiological factors of liver cancer,the fastest reduction in incidence was observed in hepatitis B virus-related liver cancer among Chinese women,and the fastest increase was in nonalcoholic steatosis hepatitis(NASH)-related liver cancer among American men.The greatest reduction in the incidence of liver cancer was observed at the age of 53 years in Chinese men(-5.2%/year)and 33 years in Chinese women(-6.6%/year),while it peaked at 58 years old in both American men and women(4.5%/year vs.2.8%/year).Furthermore,the period risks of alcohol-and NASH-related liver cancer among Chinese men have been elevated since 2013.Simultaneously,leveled-off period risks were observed in hepatitis C viral-related liver cancer in both American men and women.Conclusions::Currently,both viral and lifestyle factors have been and will continue to play an important role in the time trends of liver cancer in both countries.More tailored and efficient preventive strategies should be designed to target both viral and lifestyle factors to prevent and control liver cancer.

Changes in the epidemiology of hepatitis A in three socio-economic regions of China,1990-2017

Background:Hepatitis A(HepA)vaccination and economic transitions can change the epidemiology of HepA.China's Gross Domestic Product(GDP)per capita was known to be inversely associated with the incidence of HepA,but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking.We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China.Methods:We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season.We categorized the country into three regions,the sequential years into five era,compared the incidence,quartile age;seasonal intensity and coverage of HepA of the three regions.Linear regression was peiformed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence.Results:The annual mean incidences of HepA in the eastern,central,and western regions decreased from 63.52/100000,50.57/100000 and 46.39/100000 in 1990-1992 to 1.18/100000,1.05/100000 and 3.14/100000 in 2012-2017,respectively.Decreases in incidence were seen in all age groups in the three regions;the incidence was highest(9.3/100000)in the youngest age group(0-4 years)of the western region,while in the central region,the age group with the highest incidence changed from 0 to 9 years to adults>60 years old.In 2017,the median age of HepA cases was 43 years(Q-Q3:33-55),47 years(Q1-Q3:32-60)and 33 years(Q1-Q3:9-52)in the eastern,central,and western provinces,respectively.Seasonal peaks became smaller or were nearly elimination nationwide,but seasonality persisted in some provinces.After the Expanded Program on Immunization(EPI)included HepA vaccine into the routine schedule in 2007,HepA coverage increased to>80%in the three regions and was negatively association with the HepA incidence.Conclusion:The incidence of HepA decreased markedly between 1990 and 2017.A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China's EPI system,but inequity in incidence still existed in lower socio-economic developed region.

2020年全国医院感染监控网丙型肝炎病毒感染监测报告

目的了解医疗机构住院患者丙型肝炎病毒(HCV)感染情况及变化趋势,为制定HCV感染防控策略提供参考依据。方法对2020年上报至全国医院感染监控网医院感染横断面调查资料中HCV感染监测结果进行汇总分析,HCV阳性为血清抗-HCV阳性或HCV RNA阳性,并与2003年调查结果进行比较。结果2020年1573所医院调查住院患者1071368例,其中738535例患者进行了HCV相关检测,4014例存在HCV感染,检测率为68.93%,HCV阳性率为0.54%。男性患者HCV阳性率为0.60%,女性患者为0.48%,两者比较差异有统计学意义(χ^(2)=47.18,P<0.001)。年龄段以50~<60岁组HCV阳性率最高(0.76%),其次为40~<50岁组,HCV阳性率为0.71%,各年龄段比较差异有统计学意义(χ^(2)=696.74,P<0.001)。2003年调查住院患者91113例,35145例进行HCV相关检测,检测率为38.57%,775例存在HCV感染,HCV阳性率为2.21%。2020年不同规模医院HCV阳性率为0.46%~0.63%,以医院床位数600~899张者最高,不同规模医院患者HCV阳性率比较,差异有统计学意义(χ^(2)=35.34,P<0.001)。2020年有12个省/直辖市/自治区HCV相关检测患者人数>10000例,HCV阳性率为0.19%~0.81%,以海南省最高;不同科室HCV阳性率为0.06%~0.82%,以儿科HCV阳性率最低,内科HCV阳性率最高。2003、2020年HCV阳性率均以感染病科最高,分别为7.95%、3.48%,2003年其次为整形科(7.72%)、消化科(3.77%)、肾病科(3.57%)、综合重症监护病房(ICU,3.10%),2020年其次为消化科(1.35%)、肾病科(1.18%)、内分泌科(0.91%)、综合ICU(0.79%)。结论与2003年相比,2020年HCV阳性率明显下降。HCV感染患者主要分布在感染病科,其次为消化科、肾病科及综合ICU,HCV感染阳性率存在性别、年龄、地域的差异。

The Complex Dynamics of Hepatitis B Infected Individuals with Optimal Control

This paper proposes various stages of the hepatitis B virus(HBV)besides its transmissibility and nonlinear incidence rate to develop an epidemic model.The authors plan the model,and then prove some basic results for the well-posedness in term of boundedness and positivity.Moreover,the authors find the threshold parameter R0,called the basic/effective reproductive number and carry out local sensitive analysis.Furthermore,the authors examine stability and hence condition for stability in terms of R0.By using sensitivity analysis,the authors formulate a control problem in order to eradicate HBV from the population and proved that the control problem actually exists.The complete characterization of the optimum system was achieved by using the 4th-order Runge-Kutta procedure.

肝爽颗粒联合替诺福韦治疗慢性乙型肝炎肝纤维化的疗效分析

目的 探讨肝爽颗粒联合替诺福韦治疗慢性乙型肝炎肝纤维化患者的疗效分析。方法 选取2020年1月—2022年1月医院收治的72例慢性乙型肝炎肝纤维化患者,依照随机数表法随机分为试验组和对照组各36例。对照组采用替诺福韦治疗,试验组在对照组的基础上另给予肝爽颗粒治疗,2组均治疗16周。比较临床疗效、肝功能指标(总胆红素[TBiL]、谷草转氨酶[AST])、肝硬化指标(透明质酸[HA],层黏连蛋白[LN])及不良反应。结果 试验组总有效率高于对照组(P<0.05)。治疗后,两组AST、TBiL水平较治疗前均降低(P<0.05),试验组AST、TBiL水平均低于对照组(P<0.05);两组HA、LN较治疗前均降低(P<0.05),试验组HA、LN均低于对照组(P<0.05),试验组不良反应发生率13.89%与对照组11.11%比较,差异无统计学意义(P>0.05)。结论 肝爽颗粒联合替诺福韦治疗慢性乙型肝炎肝纤维化患者疗效显著,改善肝功能,减轻肝硬化,安全可靠,值得推广。

泉州市扩大国家免疫规划前后甲型病毒性肝炎流行病学特征分析

目的:了解福建省泉州市扩大免疫规划前后甲型病毒性肝炎的流行病学特征,为相关部门制定防控措施提供参考依据。方法:收集整理中国疾病预防控制信息系统中2004—2022年泉州市报告的甲型病毒性肝炎病例数据资料,采用描述性研究方法分析泉州市甲型病毒性肝炎病例的流行病学特征。结果:2004—2022年泉州市共报告甲型病毒性肝炎2610例,年均报告发病率为1.71/10万,发病率由2004年的2.32/10万下降至2022年的1.25/10万,报告发病率呈下降趋势;年均报告发病率居前3位的县(市、区)为南安市、晋江市、鲤城区,泉州台商投资区年均报告发病率最低;0~14岁、15~29岁、30~44岁年龄段人群发病均呈下降趋势,45~59岁、60~74岁年龄段人群发病均呈上升趋势;报告发病人数最多的职业为农民。结论:2008年泉州市将甲型病毒性肝炎疫苗纳入免疫规划后,甲型病毒性肝炎总体报告发病率呈下降趋势,0~14岁年龄段人群发病例数显著下降。相关部门应继续开展甲型病毒性肝炎监测工作,加大疫苗接种宣传教育力度,针对重点人群制定防控策略,从而进一步降低泉州市甲型病毒性肝炎的发病率。

辽宁省西部某县2011年1月至2021年12月乙型病毒性肝炎发病率的时空分布特征

目的:了解辽宁省西部某县2011年1月至2021年12月乙型病毒性肝炎(简称乙型肝炎)发病情况及其时空分布特征。方法:从该县疾病预防控制中心获取乙型肝炎资料,计算粗发病率及标化发病率;采用ArcGIS软件进行乙型肝炎发病情况的全局自相关分析及局部自相关分析,采用SaTScan软件进行时空扫描分析获取乙型肝炎发病的病例分布及时空聚集情况。结果:2011年1月至2021年12月该县乙型肝炎累计病例2978例,粗发病率为69.25/10万,标化发病率为70.13/10万。乙型肝炎粗发病率以头台满族镇最高,其次是高台子镇和城关街道。2014年、2016年、2019年、2021年该县全局自相关呈聚集分布;局部自相关发病热点区域聚集在该县中、西部,H-H聚集区域于2014至2016年有头台满族镇、九道岭镇,2017至2019年有头道河满族乡、义州街道、城关街道,2020至2021年有前杨镇和义州街道;L-L聚集地区多集中于该县西南部,为地藏寺满族乡、大定堡满族乡和留龙沟满族乡;时空扫描分析共得到4个聚集区域,一级区域为2017年的张家堡乡,二级区域包括2011至2015年的前杨镇和城关街道,三级区域为2013至2016年的高台子镇,四级区域为2014至2017年的头台满族镇。结论:2011年1月至2021年12月辽宁省西部某县乙型肝炎发病地区主要集中在中部和西北部,中西部的聚集性高,且有随时间推移逐渐向北部地区扩散的趋势,应重视乙型肝炎高发乡镇并进行有效预防监测管理。

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。