包头市三所综合性医院门诊病人乙型肝炎流行病学现况研究

发布时间：2018-06-16 16:52

本文选题：乙型肝炎 + 血清学　；参考：《山东大学》2009年硕士论文

【摘要】： 研究背景:乙型病毒性肝炎(简称乙肝)是由乙型肝炎病毒(HBV)引起的一种传染性疾病。HBV可通过多种途径传播,主要是经输血和使用血液制品传播、医源性传播、母婴传播和密切接触传播等方式。目前没有治愈乙肝的特效药,乙肝病程迁延,愈后差,易转变为慢性肝炎、肝硬化及肝癌,它是除吸烟以外导致人类癌症的第二种严重的疾病。全世界约20亿人曾感染过乙型肝炎病毒(HBV),其中5.5亿成为慢性HBV感染者。我国人群HBV感染率为57.63%,HBsAg携带率为9.75%,后者约25%最终转化为慢性肝病,包括肝硬化和原发性肝细胞癌。我国因慢性乙型肝炎及相关疾病(肝硬化,肝癌)每年造成的直接经济损失高达1122.8亿元人民币。因此,乙型肝炎已成为严重威胁人类健康的传染病,是已知各型病毒性肝炎中危害最严重的一个型别,是一个严重的公共卫生问题,已被WHO列为要加强控制并最终消灭的传染病。实践证明,乙肝的控制如同其它疫苗可预防疾病一样,通过免疫预防接种,提高易感人群对HBV的免疫力是一种最有效的措施,接种乙肝疫苗是预防和控制乙肝最经济、最有效的手段。1991年,WHO在喀麦隆的雅温德召开了“发展中国家控制乙肝的国际会议”,并通过了消除乙肝的“雅温德宣言”。根据WHO的建议,凡人群HBsAg阳性率超过5%的国家和地区应实施全体新生儿乙肝疫苗免疫。为加强我国乙肝的预防控制工作,我国政府采取以儿童乙肝疫苗计划免疫为主的预防策略,于1992年将乙肝疫苗纳入儿童计划免疫管理,要求所有新生儿均应接种乙肝疫苗,但疫苗及其接种费用需由家长支付;2002年我国又正式将乙肝疫苗纳入儿童计划免疫,由国家财政支持,为所有新生儿免费接种乙肝疫苗。随着流行病学研究的深入以及其他一些相关因素的改变,乙肝的预防策略应随之不断进行调整,并通过调查与监测的方法对乙肝预防策略的实施效果适时进行评价,根据调查与监测的结果有助于预防策略的及时调整。1992年全国病毒性肝炎大规模调查距今已有17年之久,为了解包头市现阶段不同地区、不同人群中乙肝的感染现状和流行特征,评价长期以来采取的乙肝防制措施效果,特别是实施大规模乙肝疫苗接种后的效果,为进一步调整和完善包头市乙肝的防制措施提供科学依据,配合全国开展的乙肝血清流行病学调查,按照2008年全国人群乙肝等有关疾病血清学调查方案在包头市三所综合性医院开展了本次乙肝病毒感染的血清流行病学门诊调查。研究目的:通过对包头市三所综合性医院门诊乙肝五项检测病人的调查研究,了解包头市三所综合医院门诊病人乙型肝炎病毒(HBV)的感染现状及流行特征;了解包头市三所综合医院门诊病人乙型肝炎(乙肝)疫苗免疫接种情况:为制定预防和控制乙型肝炎在人群中的传播和流行的策略和措施提供信息和依据。研究方法:(1)抽样方法:采用分层整群抽样法。分别不定期抽取2008年6月31日至2009年7月1日期间包头市三区(昆都仑区、青山区、东河区)内三所综合性医院门诊血液乙肝五项检测患者1768名作为研究对象。(2)调查方法:对每个调查对象按统一调查表进行询问调查,同时采集静脉血,分离血清,低温保存,检测相关指标。(3)检测方法:用酶联免疫法(ELISA)检测乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗-HBs)和乙肝病毒核心抗体(抗-HBc)。(4)统计方法:所有资料录入EpiData3.1数据库后,用SPSS11.5软件进行统计处理和分析。主要结果:(1)人口学特征:调查对象涉及到不同地区、年龄、性别、婚姻等。其中城乡人口比为2.33:1;1～岁、14岁～人群年龄构成比为1:21.33;男女性别比为1:1.60。(2)乙肝疫苗接种情况:包头市三所综合医院门诊做乙肝五项检测的病人平均乙肝疫苗接种率为53.9%;不同性别、年龄、职业、文化程度、婚姻状况、城乡人群乙肝疫苗接种率经统计学检验,有显著性差异:不同民族、肝炎患病史人群乙肝疫苗接种率经统计学检验无显著性差异。(3)HBV感染标志血清流行病学特征:包头市三所综合医院门诊病人HBsAg总阳性率为8.5%,且不同性别、不同民族、不同文化程度、不同肝炎患病史的人群的HBsAg阳性率比较显著性差异;抗-HBs总阳性率为28.5%,且不同职业、文化程度、婚姻状况、地区、肝炎患病史人群的抗-HBs阳性率经统计学检验有显著性差异;抗-HBc的总阳性率为8.9%,且不同性别、民族、肝炎患病史的人群其抗-HBc阳性率经统计学检验有显著性差异。结论:本次调查的人群为包头市三所综合医院门诊乙肝五项检测患者,其HBsAg阳性率为8.5%,接近乙型肝炎中流行地区(8%＞HBsAg阳性率≥2%),低于我国人群HBsAg携带率(9.75%);其中1992年乙肝疫苗纳入儿童计划免疫管理以后出生的14岁以下儿童HBsAg阳性率发生显著下降,而14岁～以上青少年成人组HBsAg阳性率变化不明显;说明实施大规模乙肝疫苗接种是控制HBV感染最有效的措施,提示今后在重点做好计划免疫人群乙肝疫苗接种的同时,还应提高成人乙肝疫苗接种免疫。
[Abstract]:Background: hepatitis B virus (HBV) is a contagious disease caused by hepatitis B virus (HBV)..HBV can be transmitted through a variety of ways, mainly through transfusions and use of blood products, iatrogenic transmission, mother to child transmission and close contact transmission. There is no special drug to cure hepatitis B at present. The course of hepatitis B is deferred. It is the second serious disease of human cancer that causes chronic hepatitis, cirrhosis and liver cancer. About 2 billion people all over the world have been infected with hepatitis B virus (HBV), of which 550 million become chronic HBV infection.
The rate of HBV infection is 57.63% in China and 9.75% in HBsAg, and about 25% of the latter is transformed into chronic liver disease, including liver cirrhosis and primary hepatocellular carcinoma. The direct economic loss caused by chronic hepatitis B and related diseases (liver cirrhosis, liver cancer) is up to 112 billion 280 million yuan per year in China. Therefore, hepatitis B has become a serious threat. Human health infectious diseases, one of the most serious types of viral hepatitis known to be known, are a serious public health problem and have been listed by the WHO as an infectious disease that is to be strengthened and eventually eliminated.
It has been proved that the control of hepatitis B, like other vaccines, is the most effective measure to improve the immunity of the susceptible population to HBV by immunization, which is the most effective way to prevent and control hepatitis B, and the most effective means of hepatitis B vaccination in.1991, WHO, in Cameroon, held "the developing country control B". "The International Conference on the liver" and the adoption of the "Ya Wendy declaration" to eliminate hepatitis B. According to the suggestion of WHO, the hepatitis B vaccine should be carried out in all the countries and regions with the positive rate of more than 5% of the HBsAg. In order to strengthen the prevention and control of hepatitis B in our country, the government adopts the prevention strategy based on the planned immunization of children's hepatitis B vaccine, In 1992, hepatitis B vaccine was incorporated into the management of planned immunization for children. All newborns should be vaccinated with hepatitis B vaccine, but the cost of the vaccine and its vaccination should be paid by parents. In 2002, the hepatitis B vaccine was formally incorporated into the planned immunization of children, and the national financial support was supported by the state to vaccinate all new children free of charge of hepatitis B. In depth and the change of other related factors, the prevention strategy of hepatitis B should be adjusted continuously, and the effect of the implementation of hepatitis B prevention strategy is timely evaluated through investigation and monitoring. According to the results of investigation and monitoring, the prevention strategy is helpful to the timely adjustment of the.1992 national viral hepatitis survey in a large scale. For 17 years now, in order to understand the current status and epidemic characteristics of hepatitis B infection in different regions and different populations in Baotou, the effect of hepatitis B prevention measures adopted for a long time, especially after the implementation of the large-scale hepatitis B vaccination, provides a scientific basis for further adjustment and good measures for the prevention and control of hepatitis B in Baotou. In accordance with the nationwide survey of hepatitis B seroepidemiology, a serological survey on hepatitis B virus infection was carried out in three comprehensive hospitals in Baotou in 2008 according to the serological survey program of hepatitis B and other related diseases in the whole country.
Objective: to understand the infection status and epidemic characteristics of hepatitis B virus (HBV) in outpatients of three general hospitals in Baotou and to understand the immunization of hepatitis B (hepatitis B) vaccine in three general hospitals in Baotou city by investigating five patients in three comprehensive hospitals in Baotou. Prevention and control of hepatitis B infection in the population and the dissemination of strategies and measures to provide information and evidence.
Research methods: (1) sampling method: stratified cluster sampling method was adopted. Five cases of hepatitis B in three comprehensive hospitals in three districts (Kun Lun District, Qingshan District, Donghe District) in Baotou city from June 31, 2008 to July 1, 2009 were selected as the research subjects. (2) the investigation method: each survey object was unified. Questionnaire survey, collecting venous blood, separating serum, cryopreservation and detecting related indexes. (3) detection methods: detection of hepatitis B virus surface antigen (HBsAg), hepatitis B virus surface antibody (anti -HBs) and hepatitis B virus nuclear antibody (anti -HBc) by enzyme linked immunoassay (ELISA). (4) statistical methods: all data were recorded in EpiData3.1 database After that, the SPSS11.5 software is used to carry out statistical processing and analysis.
Main results were as follows: (1) demographic characteristics: the subjects involved in different areas, age, sex, marriage, and so on. The ratio of urban and rural population was 2.33:1; the ratio of age to age of 1 to age, age composition ratio of 14 years to population was 1:21.33; sex ratio of male and female was 1:1.60. (2) hepatitis B vaccination: the average hepatitis B in five tests of hepatitis B in three general hospitals in Baotou City The vaccine inoculation rate was 53.9%. The different sex, age, occupation, educational level, marital status and the rate of hepatitis B vaccination in urban and rural population were statistically significant differences. There was no significant difference between the different ethnic groups and the hepatitis B vaccine inoculation rate in the patients with the history of hepatitis. (3) the sero epidemiological characteristics of the HBV infection markers: three in Baotou The total positive rate of HBsAg in the outpatient of the general hospital was 8.5%, and the positive rate of HBsAg positive of the people with different nationalities, different ethnic groups, different cultural degrees and the history of hepatitis and disease was significantly different. The total positive rate of anti -HBs was 28.5%, and the anti -HBs positive rate of different occupations, educational level, marital status, region, and the population of hepatitis patient history was statistically tested. The total positive rate of anti -HBc was 8.9%, and the anti -HBc positive rate of the people with different sex and nationality and the history of hepatitis patients had significant difference after statistical test.
Conclusion: the population of this survey is five cases of hepatitis B in three general hospitals in Baotou. The positive rate of HBsAg is 8.5%, which is close to the epidemic area of hepatitis B (8% > HBsAg positive rate > 2%), which is lower than the HBsAg carrying rate (9.75%) of the population in our country. In 1992, the hepatitis B vaccine was brought under 14 years of age after the planned immunization of children. The positive rate of child HBsAg decreased significantly, but the positive rate of HBsAg in young adults aged 14 years and above was not obvious. It indicated that the most effective measure to control HBV infection was to carry out the large-scale hepatitis B vaccination. It suggested that the vaccination of hepatitis B vaccine in the planned immunization population should be improved in the future, and the immunization of adult hepatitis B vaccine should be improved.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R512.62;R181.3

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