江苏省一般人群乙型肝炎病毒感染现况及其影响因素的研究

发布时间：2018-01-11 09:29

本文关键词：江苏省一般人群乙型肝炎病毒感染现况及其影响因素的研究　出处：《南京医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的:(1)调查分析江苏省张家港、丹阳和泰兴三个县(市)一般人群乙型肝炎病毒(Hepatitis B Virus, HBV)表面抗原(HBsAg)阳性率,研究一般人群慢性HBV感染的流行特征,并分析其相关影响因素,为进一步采取有针对性干预措施,提高乙型病毒性肝炎综合防治水平提供依据。(2)通过乙型肝炎病毒表面抗原(HBsAg)、表面抗体(Anti-HBs)和核心抗体(Anti-HBc)三项指标的检测,分析一般人群中乙型病毒性肝炎感染现状,为指导采取适宜的乙型病毒性肝炎免疫策略,降低全人群的乙型病毒性肝炎感染率提供科学依据。(3)比较国产酶联免疫吸附试验试剂与雅培化学发光微粒子免疫分析法检测HBsAg与Anti-HBs的结果,评价国产酶联免疫吸附试验试剂在乙肝慢性感染率或人群免疫水平调查中的应用价值。方法:(1)采用分地区整群随机抽样的方法确定调查对象,开展问卷调查、采集静脉血、检测HBsAg,采用单因素和多因素Logistic回归方法对HBsAg阳性相关影响因素进行分析。(2)对随机抽取1936例血清样本应用雅培化学发光微粒子免疫分析法进行HBsAg、Anti-HBs与Anti-HBc检测,并与国产酶联免疫吸附试验试剂检测HBsAg和Anti-HBs进行比较,分析国产酶联免疫吸附试验试剂的检测敏感性和特异性。结果:(1)张家港、丹阳和泰兴抽样人群的HBsAg阳性率分别为5.11%、7.83%和9.77%,按2000年全国人口年龄构成标化后,张家港、丹阳和泰兴的HBsAg标化阳性率分别为4.32%、6.54%和9.25%。18岁以上计划免疫前出生人群HBsAg阳性率均显著高于18岁以下计划免疫后出生人群,18-40岁年龄段人群HBsAg阳性率有随年龄升高而升高的趋势。三个地区中18岁以上年龄组中接种乙型肝炎疫苗人群的HBsAg阳性率均明显低于未接种乙肝疫苗人群。男性、住院、纹身、穿刺、共用针具、共用剃刀为乙型病毒性肝炎感染的危险因素,接种乙肝疫苗则是保护因素,献血与乙型病毒性肝炎感染有负相关关系。(2)1936例血清样本乙肝感染流行率的三项指标(HBsAg、Anti-HBs、Anti-HBc)检测结果显示,该人群中HBsAg、Anti-HBs和Anti-HBc的阳性率分别为12.45%、60.49%和58.78%。HBV血清学三项指标全阴性者共324例,占16.74%;慢性HBV感染者共221例,占11.41%;对HBV具有保护性免疫力者共464例,占23.97%;HBV既往感染者共907例,占46.85%。HBV血清学三项指标全阴性者主要集中在15-40岁年龄组,慢性HBV感染率与HBV既往感染率均随年龄的增长而增加,而对HBV具有保护性免疫力者则随年龄的增长而减少。(3)国产酶联免疫吸附试验试剂的检测敏感性和特异性的检验结果显示,在HBsAg检测中,校正配对χ2=26.04,P0.0001,表明本研究所采用的ELSIA法与雅培CMIA法两种方法检测结果存在不同,但两者kappa值=0.9373,表明ELISA法(HBsAg)与雅培检测的一致性很强,其灵敏度与特异度分别为88.38%、100%。两个方法进行Anti-HBs检测时,存在84例的判读结果不一致。参照雅培定量检测结果为标准,ELISA法(Anti-HBs)灵敏度和特异度分别为95.47%、95.95%。结论:张家港、丹阳和泰兴的乙型肝炎疫苗纳入儿童计划免疫已显成效,儿童组HBsAg阳性率明显降低,成人乙型肝炎疫苗接种也可获得明显效果。因此,在完善儿童乙肝计划免疫的同时,应抓紧成人乙肝免疫策略研究。乙肝感染的危险因素还普遍存在,在成人中乙肝感染的状况依然严峻,不断加强乙肝防治知识的宣传教育,提高群众预防乙肝感染的能力。国产HBsAg酶联免疫吸附试验试剂特异度高,一般不会误诊,但有一定的漏诊率,可满足一般人群慢性感染者的流行病学调查,而Anti-HBs酶联免疫吸附试验试剂的灵敏度和特异性还有待进一步提高。
[Abstract]:Objective: (1) the investigation and analysis of Jiangsu province Zhangjiagang, Danyang and Taixing three counties (city) the general population of hepatitis B virus (Hepatitis B, Virus, HBV) surface antigen (HBsAg) positive rate, epidemiological characteristics of chronic HBV infection in the general population, and analyze the related factors, to take further intervention measures targeted to provide the basis for improving the level of prevention and treatment of hepatitis B virus. (2) by hepatitis B virus surface antigen (HBsAg), surface antibody (Anti-HBs) and core antibody (Anti-HBc) detection of the three indicators, analysis of the status quo of hepatitis virus infections in the general population, take appropriate immunization strategy for hepatitis B virus B as a guide, to provide a scientific basis to reduce the rate of hepatitis B virus infection. The total population (3) to compare the ELISA reagent and Abbott chemiluminescence microparticle immunoassay for detection of HBsAg and Anti-HBs. To evaluate the application value of domestic enzyme linked immunosorbent test reagents in the investigation of chronic hepatitis B infection rate or population immunity level.
Methods: (1) using the method of regional cluster random sampling to determine the survey, conducted a questionnaire survey, collected venous blood to detect HBsAg by Logistic univariate and multivariate analysis of factors influencing HBsAg positive regression method. (2) the HBsAg of randomly selected 1936 cases of serum samples by Abbott chemiluminescence microparticle immunohistochemical analysis of Anti-HBs and Anti-HBc detection, and domestic ELISA kit for detection of HBsAg and Anti-HBs were compared. The detection sensitivity and specificity analysis of domestic ELISA kit.
Results: (1) Zhangjiagang, Danyang and Taixing, the positive rate of HBsAg in the sample population were 5.11%, 7.83% and 9.77%, according to the 2000 national population age standardized, Zhangjiagang, Danyang and Taixing HBsAg standard positive rates were 4.32%, 6.54% and 9.25%.18 years old people born before birth plan immune positive rate among HBsAg were significantly higher than those under the age of 18 after immunization, 18-40 HBsAg years old age group the positive rate had increased trend with age. The positive rate of HBsAg age group over 18 years old in the hepatitis B vaccine population in three was significantly lower than that of hepatitis B vaccination groups. Male, hospitalization, tattoo, puncture, sharing needles, razor shared risk factors of hepatitis B infection, hepatitis B vaccination are the protective factors, blood infection and hepatitis B virus were negative correlation. (2) serum samples of HBV infection in 1936 cases The prevalence rate of the three indicators (HBsAg, Anti-HBs, Anti-HBc) test results showed that the HBsAg population, the positive rate of Anti-HBs and Anti-HBc were 12.45%, 60.49% and three indexes of 58.78%.HBV serological negative were 324 cases, accounting for 16.74%; 11.41% for a total of 221 cases of chronic HBV infection; HBV has protection immunity in 464 cases, accounting for 23.97%; the previous HBV infection were 907 cases, accounting for three of all negative serological indicators of 46.85%.HBV mainly concentrated in the 15-40 age group, HBV rate and infection rates were increased significantly with age of chronic HBV infection, while the HBV has the protective immunity is decreased the growth of the age. (3) detection sensitivity and specificity of the results of domestic enzyme-linked immunosorbent assay showed that in HBsAg detection, correction of paired x 2=26.04, P0.0001, showed that the ELSIA method and CMIA method are two Abbott The results are different, but both the value of kappa =0.9373 show that the ELISA method (HBsAg) consistent with Abbott detection is very strong, its sensitivity and specificity were 88.38%, two 100%. method to detect Anti-HBs, there are 84 cases of interpretation of inconsistent results. According to Abbott quantitative detection results for the standard ELISA method (Anti-HBs) the sensitivity and specificity were 95.47%, 95.95%.
Conclusion: Zhangjiagang children's immunization of hepatitis B vaccine has been produced in Danyang and Taixing in children, the positive rate of HBsAg was significantly decreased, adult hepatitis B vaccination can obtain obvious effect. Therefore, to improve the children's hepatitis B immunization program at the same time, should study on hepatitis B immunization strategy. People pay close attention to the risk factors of hepatitis B infection also generally, hepatitis B infection in adults in the situation is still grim, continue to strengthen publicity and education of knowledge of hepatitis B prevention, improve the masses prevention ability of HBV infection. Domestic HBsAg ELISA kit of high specificity, generally not misdiagnosis, but there is a certain rate of missed diagnosis, epidemiological investigation can meet the needs of the general population of chronic infection however, Anti-HBs ELISA reagent sensitivity and specificity remains to be further improved.

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R186

【参考文献】