摘要
目的了解散发成人急性乙型肝炎(AHB)流行病学特征及其血清病毒标志物(HBV M)演变规律。方法以202例成人AHB患者为研究对象,收集患者流行病学资料并定期随访检测ALT、TBil、HBV DNA、HBV M及其定量,观察其动态变化,随访期为48周。计数资料采用非参数秩和检验,计量资料组间比较采用成组t检验,相关性分析采用Person检验。结果 AHB患者男性明显多于女性,平均(42.99±7.31)岁。微量血传播方式最多,占29.20%,异性性传播占17.33%,但高达48.02%的患者传播途径不明。就诊时仅49.01%的患者HBV DNA阳性。HBV DNA阳性组血清ALT平均值为(1973.2±445.3)U/L;阴性组为(1500.3±287.7)U/L,两者差异无统计学意义(t=1.852,P>0.05);HBV DNA阳性组血清TBil平均值为(118.40±37.33)μmol/L;阴性组为(81.06±23.24)μmol/L,两者差异有统计学意义(t=2.765,P<0.01)。初诊时HBV M呈现8种模式,以HBsAg、HBeAg、抗-HBc、抗-HBc IgM阳性和HBsAg、抗-HBe、抗-HBc、抗-HBc IgM阳性2种模式最多见,分别占39.11%和29.27%。资料完整的99例AHB患者HBV M动态观测显示:观测期内HBsAg阴转率为97.98%,平均阴转时间为2.5周;抗-HBs累计阳转率为83.84%;HBeAg阳性患者HBeAg阴转率为100.00%,全部于发病4周内阴转;在48周的随访期内抗-HBe阳转率为80.81%;血清抗-HBc始终为阳性。202例患者急性期HBsAg定量均低于200 ng/ml;急性期HBsAg定量水平与HBsAg阴转时间呈反比。结论经微量血传播及性接触传播已成为成人散发AHB的主要传播途径;HBV DNA快速清除和HBsAg、HBeAg快速血清学转换是成人散发AHB的显著特点;急性期HBsAg定量水平对判定AHB转归有一定意义,本文2例患者最终转化为慢性HBV感染。
Objective To investigate the epidemiological features and serological changes in sporadic acute hepatitis B （AHB） among a- dults. Methods A total of 202 adult patients with AHB were selected as subjects. The epidemiological data of patients were collected, and follow - up was regularly performed for 48 weeks to monitor alanine aminotransferase （ ALT）, total bilirubin （ TBil）, hepatitis B virus （HBV） DNA, and serological markers of HBV （ HBV - Ms）. Categorical data were analyzed by nonparametric rank sum test; comparison of continuous data between groups was made by independent - samples t test ; correlation analysis was performed by Pearson test. Results A- mong AHB patients, there were more males than females; the mean age was 42.99 ±7.31 years. Of all cases, 29.20% developed the dis- ease by micro blood transmission, 17.33% by heterosexual transmission, and 48.02% by unknown route of transmission. Only 49.01% of the patients were positive for HBV DNA when visiting the hospital. The HBV DNA - positive group had a serum ALT level of 1973.2± 445.3 U/L, and the HBV DNA - negative group had a serum ALT level of 1500.3 ±287.7 U/L, without significant difference between the two groups （ t=1. 852, P 〉 0. 05 ）. The HBV DNA - positive group had a serum TBil level of 118.40±37.33 μmol/L, and the HBV DNA - negative group had a serum TBil level of 81.06± 23.24 ~Lmol/L, with significant difference between the two groups （ t = 2. 765, P 〈 0. 01 ）. Eight patterns of HBV - Ms were found in the patients who first visited the hospital; in the most frequent pattern, which was seen in 39.11% of patients, HBsAg, HBeAg, anti - HBc, and anti - HBc IgM were detected, and in the second most frequent pattern, which was seen in 29.27% of patients, HBsAg, anti -HBe, anti -HBc, and anti -HBc IgM were detected. The monitoring of HBV -Ms in 99 AHB patients who had complete data showed that the negative conversion rate of HBsAg was 97.98% , and the average negative conversion time was 2.5 weeks; the cumulative positive conversion rate of anti - HBs was 83.84% ; the negative conversion rate of HBeAg among HBeAg - positive patients was 100%, and all showed negative conversion within 4 weeks of onset; the positive conversion rate of anti -HBe was 80. 81% in the 48 - week follow - up; serum anti - HBc remained detectable. In the acute phase, the 202 patients had HBsAg levels below 200 ng/ ml, and the HBsAg level was inversely proportional to the negative conversion time of HBsAg. Conclusion Micro blood transmission and sexual transmission have become the main routes of transmission for sporadic AHB among adults. Rapid HBV DNA clearance and rapid sero- conversion of HBsAg and HBeAg are the characteristics of sporadic AHB among adults. The HBsAg level in acute phase is helpful for deter- mining the outcome of AHB. In this study, 2 cases were finally converted into chronic HBV infection.
出处
《临床肝胆病杂志》
CAS
2014年第1期30-33,共4页
Journal of Clinical Hepatology
基金
上海市黄浦区卫生事业发展奖励基金(2009HGG-26)
