安徽省皖江部分地区自然人群乙型肝炎流行现况

发布时间：2018-02-24 10:21

本文关键词： 乙型肝炎病毒血清流行病学免疫接种基因型巢式聚合酶链反应　出处：《安徽医科大学》2009年硕士论文　论文类型：学位论文

【摘要】： 目的了解现阶段安徽省皖江地区自然人群乙型肝炎流行水平与流行强度及乙肝疫苗的接种情况;描述乙肝病毒(HBV)感染状况及HBV基因型的分布状况;探讨HBV感染主要血清标志物与基因型的关系。为了解安徽省乙肝流行规律提供基础,为乙肝防治工作提供依据。方法(1)以安徽省巢湖市、池州市为研究现场。自行设计调查问卷,采用分层整群抽样方法对2个城市小区、7个农村行政村的自然人群开展以家庭为单位的问卷调查。问卷内容包括:一般人口学资料,乙肝相关知识,医源性接触史,免疫史及生活接触史。 (2)问卷调查完成后,每名调查对象抽取3ml肘静脉血,共采集血标本2282份。对所收集的血标本用ELISA方法检测HBV感染标志,即乙肝五项HBsAg、HBsAb、HBeAg、HBeAb及HBcAb;对224份表面抗原(HBsAg)阳性的血清用浓缩液裂解法提取HBV DNA;用型特异性引物巢式PCR法检测HBV DNA A-F基因型。结果(1)在2282例血清标本中,乙肝五项HBsAg、HBsAb、HBeAg、HBeAb及HBcAb流行率分别为9.8%、43.5%、1.0%、7.8%、10.3%;HBV总感染率(HBV流行率)为40.6%(926/2282);标化HBsAg流行率为9.3%,标化HBV流行率为35.4%。HBsAg流行率男性高于女性(χ~2= 3.992,P0.05),HBsAg流行率城乡差异不显著(χ~2=0.027,P0.05)。乙肝疫苗接种率为24.7%(539/2282),10岁以下年龄组疫苗接种率最高为97.4%(76/78),学生疫苗接种率较高为78.2%(355/454),农村人群疫苗接种率(19.1%)低于城市人群(37.6%)(χ~2=84.682,P0.01)。接种乙肝疫苗后HBsAg及HBV流行率均显著降低(P0.01)。 (2)在224份HBsAg阳性的血标本中,共呈现5种模式:①HBsAg、HBeAg、HBcAb(1、3、5项)均阳性者18例(8.0%),②HBsAg、HBeAb、HBcAb(1、4、5项)阳性者160例(71.4%),③HBsAg、HBcAb(1、5项)阳性者36例(16.1%),④HBsAg、HBeAg(1、4项)阳性者4例(1.8%),⑤仅HBsAg阳性者6例(2.7%)。HBV基因型检出率分别为B型54.9%、C型32.6%、BC混合型7.1%,另外有12例未分出型别(5.4%)。HBeAg阳性标本基因型检出率为100%;各基因型在HBeAg阳性组与阴性组中分布有差异(χ~2=8.323,P=0.04),C型在HBeAg阳性者中检出率(59.1%)高于HBeAg阴性者(29.7%),HBeAg阴性者B型检出率(56.9 %)高于HBeAg阳性者(36.4%)。结论(1)安徽省皖江地区HBeAg流行率为9.8%,标化流行率为9.3%,为全国乙肝高流行区;乙肝疫苗接种率为24.7%,标化率为35.7%,农村乙肝疫苗接种率偏低。乙肝疫苗的接种能有效提高抗-HBs阳性率,减少HBV感染机会。 (2)皖江地区自然人群HBV基因型以B型、C型为主,B型为优势基因型;HBV基因型与血清感染标志物有一定关系;型特异性多引物对巢式PCR方法适宜大样本的基因型检测。
[Abstract]:Objective to investigate the prevalence level and intensity of hepatitis B and the vaccination of hepatitis B vaccine among the natural population in Anhui Province at present, and to describe the status of hepatitis B virus hepatitis B virus (HBV) infection and the distribution of HBV genotypes. To explore the relationship between the main serum markers and genotypes of HBV infection, to provide the basis for understanding the epidemic rule of hepatitis B in Anhui Province, and to provide the basis for the prevention and treatment of hepatitis B. Methods 1) A questionnaire was designed in Chaohu City, Anhui Province, Chizhou City, Anhui Province. Using stratified cluster sampling method, the natural population in 2 urban districts and 7 rural administrative villages were investigated with a family questionnaire. The questionnaire included: general demographic data, hepatitis B related knowledge, iatrogenic contact history, and so on. History of immunity and life contact. 2) after the completion of the questionnaire, 2282 blood samples were collected from 3ml of cubitus vein blood collected from each of the subjects. The ELISA method was used to detect the HBV infection markers in the collected blood samples. Two hundred and twenty-four sera with positive HBsAg were extracted by concentrated solution lysis method, and HBV DNA A-F genotypes were detected by nested PCR with type specific primers. Results in 2282 serum samples, The prevalence rates of HBeAb and HBcAb in HBs were 9.8 and 9.8, respectively. The total infection rate of HBeAb and HBeAb in hepatitis B hepatitis B were 40.6 / 926 / 2282and 9.3b respectively (蠂 ~ 2 = 3.992P 0.05). There was no significant difference between urban and rural areas (蠂 ~ 2 = 0.027, P 0.05). The rate of hepatitis B vaccine vaccination was not significantly different between urban and rural areas (蠂 ~ 2 = 3.992P 0.05). The standard HBsAg prevalence rate was 9.3%, and the standard HBV prevalence rate was 35.4.HBsAg prevalence rate was higher in males than in females (蠂 ~ 2 = 3.992P 0.05) (蠂 ~ 2 = 0.027 P 0.05). The prevalence rate of hepatitis B vaccine was not significantly different between urban and rural areas (蠂 ~ 2 = 3.992P 0.05). The highest vaccination rate was 97.447% / 78% in the group under 10 years of age and the higher rate was 78.2% / 355454% in the students, and 19.1g in the rural population. It was lower than that in the urban population (蠂 2 84.682% P 0.01g). The prevalence rates of HBsAg and HBV were significantly lower than those of the urban population (蠂 284. 682% P 0. 01), and the prevalence rates of HBsAg and HBV were significantly lower than those of the urban population (蠂 2 84. 682% P 0. 01) after the hepatitis B vaccine was inoculated, the prevalence rates of both HBsAg and HBV were significantly lower than that of the urban population (P 0. 01). (2) of the 224 HBsAg positive blood samples, A total of 16. 1HBeHBeAg / HBcAb1) positive patients (18 cases with HBeAg + HBcAb1) were positive (18 cases with HBeAg + HBcAb1 / 45) (160 cases with 71.4 HBcAb15) were positive (36 cases were positive with 16. 1HBeAg / HBeAg) (4 cases with HBsAg positive only 6 cases with HBsAg positive 6 cases with HBsAg positive 6 cases with B type 54.94.9C type 32.66.6B mixed type 7.1b), and there were 6 cases with HBsAg positive only. The detection rate of HBV genotype was B type 54.94.9C type 32.66B mixed type 7.1b respectively, and there were 6 cases with HBsAg positive only. The detection rate of HBV genotype was 7.1g / c, 54.94.90%, respectively. The genotypic rate of 12 cases with positive HBeAg was 100, and there was significant difference in the distribution of genotype between HBeAg positive group and negative group (蠂 2 + 8.323). The detection rate of type C in HBeAg positive group was 59.1% higher than that in HBeAg negative group (56.9%). It was higher than that in HBeAg positive group (56.9%), and was higher than that in HBeAg positive group (56.9%), and the positive rate of HBeAg-negative group was 56.9% (P < 0.05), which was higher than that of HBeAg positive group (P < 0.05%), which was higher than that of HBeAg negative group (P < 0.05%). Conclusion (1) the prevalence rate of HBeAg is 9.8 and the standardized prevalence rate is 9.3 in Anhui Province, which is the high epidemic area of hepatitis B in China. The coverage rate of hepatitis B vaccine was 24.7% and the standardized rate was 35.7.The coverage rate of hepatitis B vaccine in rural areas was low. The positive rate of anti-HBs was increased effectively and the chance of HBV infection was reduced by the inoculation of hepatitis B vaccine. (2) the genotype of HBV in natural population in Anhui River area was mainly type B and B genotype. The genotype of HBV was related to the markers of serum infection, and the nested PCR method was suitable for the detection of genotypes in large samples.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R512.62;R181.3

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