云南省昆明市2016年某三甲医院体检人群乙肝感染现状及分子流行病学研究

发布时间：2018-04-20 02:12

本文选题：体检人群 + 乙型病毒性肝炎　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]通过对云南省2016年某三甲医院体检人群乙肝感染现状及分子生物流行病学的调查研究,了解该医院体检人群乙肝感染现状,掌握HBsAg阳性率、HBV感染率、HBsAb阳性率以及乙肝两对半检出模式、探讨基因分型分子生物学流行病学特征,为制定有针对性的防控策略和措施提供理论依据,也为云南省乙肝有效控制奠定一定的理论基础。[方法]运用描述流行病学方法,对2016年1月1日-12月31日在某三甲医院进行健康体检人群的基本情况,乙肝感染情况,乙肝五项组合模式情况,进行描述性分析。用实验室检测技术,包括ELISA检测、S区巢式PCR扩增法、基因测序等方法,进行乙肝病毒分子流行病学研究。[结果]1.乙肝感染现状2016年云南省三甲综合性医院进行体检,并进行乙肝血清五项检测的人群,37563例,男性22269人,占59.28%,平均年龄46.74±15.72岁;女性15294人,占 40.72%,45.46±15.07。男女比例为 1.46:1。HBsAg 阳性率为 2.91%,男性(3.30%)高于女性(2.35%) (P0.001), 40-49年龄组为阳性率高峰。职业以其他职业(4.6%)和生产运输行业(4.36%)阳性率较高,。不同民族中彝族(2.99%)和汉族(2.94%)阳性率较高。HBsAb 阳性率为 67.29%,女性(67.94%)高于男性(66.84%) (P0.05),30-39年龄组阳性率最高。不同职业中科研单位HBsAb阳性率最高(71.62%),企业单位职员HBsAb阳性率最低(64.26%)。不同民族HBsAb阳性率相同(P=0.082)。HBcAb阳性率为5.69%。男性HBcAb阳性率高于女性(P0.001),阳性率随年龄增长而上升。职业中阳性率最高为其它(8.30%),。其他少数民族(6.21 %)和汉族(5.80%)阳性率最高。HBV感染率为5.71%。男性HBV感染率高于女性(P0.001)。阳性率随年龄增长而上升。不同职业中其他职业感染率最高(7.55%),学生人群感染率最低(2.99%)。汉族HBV感染率高于其他民族(P0.05)。HBV易感率为29.14%。易感率无性别差异(P0.05)。39岁前易感率随年龄上升而下降,40岁后易感率随年龄上升而上升。不同职业中易感率最高为生产运输职业(52.06%),最低为部队军人(17.36%)。回族(35.07%)和彝族(30.49%)易感率高。2.乙肝血清组合模式乙肝血清五项标记物组合共检出15种模式。HBsAb单项阳性检出率最高,占65.14%,血清五项指标全阴模式次之,占29.14%, “小三阳”模式检出率居第三,占2.39%。在HBV感染的模式中(3、5、6、7、8、9),男性检出率均高于女性(P0.05)。特殊罕见模式检出15例。“小三阳”检出率60-69岁组最高(3.32%)且在69岁前检出率随年龄增长而上升。“大三阳”检出率最高组为20-29岁(0.53%),最低为70岁及以上组(0.06%),其检出率随年龄上升而下降。3、乙肝分子流行病学特征136份经检测HBsAg为阳性的样本中,115例为小三阳,占84.56%,大三阳8例,占5.88%,HBsAg、HBcAb阳性13例,占9.56%。用巢式PCR两轮共扩增136份标本,扩增成功17份。其中“大三阳”模式全部测序成功,“小三阳模式”检出9份。B基因型10例,均为B2亚型;C型7例,其中1例C1型,6例C2型。两种基因型不同性别检出情况差异无统计学意义(P0.05); B基因型中血清型均为adw2型,C基因型中有1例adw2型,6例adr+型。α抗原决定簇突变率为发现两种情况I126S有1株,为C基因型,占12.5%,S143T有7株,为B基因型,占87.5%。[结论]1.云南省2016年某三甲医院体检人群中男性HBsAg阳性率、HBcAb阳性率HBV感染率均高于女性,是乙肝感染的重点人群。2. 40-49岁人群为HBsAg高发人群。3.职业不详人群(家务及待业、自由职业、农民等)生产运输及商业服务人群HBsAg阳性率较高。4.乙肝血清组合模式以表面抗体单项阳性为主,五项全阴次之,感染模式以“小三阳”为主。5.检出B型和C型两种基因型,亚型为B2和C2型,adw2和adr+两种血清亚型与B、C基因型显著相关。6.本次检出突变率较高,有两种突变模式:S143T和I126S。且变异位点集中于第143位氨基酸。
[Abstract]:[Objective] to understand the current status of hepatitis B infection in the medical examination population of a three a hospital in Yunnan in 2016, and to understand the status of hepatitis B infection in the population of the hospital, grasp the positive rate of HBsAg, the rate of HBV infection, the positive rate of HBsAb and the two half detection mode of hepatitis B, and discuss the specific molecular biology epidemiology of the genotyping. It provides a theoretical basis for the formulation of targeted prevention and control strategies and measures. It also lays a theoretical foundation for the effective control of hepatitis B in Yunnan province. [Methods] the basic situation, the hepatitis B infection and the five hepatitis B combination pattern of the health check-up population in a three a hospital on the 31 -12 of January 1, 2016 were carried out by descriptive epidemiological methods. Descriptive analysis. Using laboratory testing techniques, including ELISA detection, S region nested PCR amplification, gene sequencing and other methods, the molecular epidemiology of hepatitis B virus was studied. [results]1. HBV infection status in 2016 in Yunnan three a comprehensive hospital was examined, and five cases of hepatitis B serum were tested, 37563 cases, male 222. 69, accounting for 59.28%, the average age of 46.74 + 15.72 years, 15294 women, 40.72%, 45.46 + 15.07. male and female 1.46:1.HBsAg positive rate 2.91%, male (3.30%) higher than women (2.35%) (P0.001), 40-49 age group is the peak of positive rate. Occupation with other occupations (4.6%) and production transportation industry (4.36%) positive rate is higher, the Yi among the different ethnic groups. The positive rate of positive rate of.HBsAb in ethnic group (2.99%) and Han (2.94%) was 67.29%, women (67.94%) was higher than male (66.84%) (P0.05), and the positive rate of the 30-39 age group was the highest. The positive rate of HBsAb in the research units in different professions was the highest (71.62%), and the positive rate of HBsAb in enterprise unit staff was the lowest (64.26%). The positive rate of HBsAb in different nationalities was the same (P=0.082).HBcAb positive. The positive rate of male HBcAb in 5.69%. was higher than that of women (P0.001), the positive rate increased with age. The highest positive rate in the occupation was other (8.30%). The highest.HBV infection rate of other ethnic minorities (6.21%) and Han (5.80%) was 5.71%. male HBV infection rate higher than female sex (P0.001). The positive rate increased with age. The rate of occupational infection was the highest (7.55%), and the infection rate of the students was the lowest (2.99%). The HBV infection rate of the Han nationality was higher than that of other nationalities (P0.05). The susceptibility rate of.HBV was 29.14%. susceptibility (P0.05), the susceptibility rate of.39 was decreased with age, and the susceptibility rate increased with age after 40 years of age. The highest susceptibility rate in different professions was the production transport service. Industry (52.06%), the lowest was Army soldiers (17.36%). Hui (35.07%) and Yi (30.49%) susceptibility rate high.2. hepatitis B serum combination model of hepatitis B serum five markers combined detection of the 15 patterns of a total of 15 models of the highest positive rate, accounting for 65.14%, the serum five index full Yin mode, accounting for 29.14%, "small three yang" pattern detection rate of third, In the model of HBV infection (3,5,6,7,8,9), the rate of male detection was higher than that of women (P0.05). 15 cases were detected in special rare pattern. The detection rate of "small three yang" was the highest (3.32%) and the detection rate before 69 years increased with age. The highest detection rate of "big three yang" was 20-29 years (0.53%), and the lowest was 70 years and above (0.06%). The detection rate decreased.3 with age. Among the 136 samples of HBsAg positive, 115 cases were small three yang, 84.56%, 8 cases of big three yang, 5.88%, HBsAg and 13 HBcAb positive, which accounted for 136 specimens of 9.56%. with nested PCR, and 17 cases were successfully amplified, and the "big three yang" model was all sequenced successfully. "Xiao San Yang model" detected 9.B genotypes in 10 cases, all of which were B2 subtypes, and 7 cases of C type, of which 1 were C1 and 6 C2. Two genotypes had no statistical difference (P0.05), the B genotypes were adw2, 1 adw2 and 6 adr+. The alpha antigen determinant mutation rate was two cases I126S. There were 1 strains, C genotype, 12.5%, and 7 S143T, which accounted for B genotype, accounting for 87.5%.[conclusion in]1. Yunnan Province, the positive rate of male HBsAg in a three a hospital of Yunnan province in 2016, HBV infection rate of HBcAb positive rate is higher than that of women. The key population of hepatitis B infection is.2. 40-49 years old for.3. occupations of HBsAg high incidence population (housework and waiting, free The positive rate of HBsAg in the population of production, transportation and commercial service was higher in the population of production, transportation and commercial service. The.4. hepatitis B serum combination pattern was mainly the single positive of surface antibody, and the five items were all negative. The infection mode was two genotypes of B type and C type with "Xiao San Yang" as the main.5.. The subtypes were B2 and C2 type, and adw2 and adr+ two serum subtypes were significantly related to B and C genotypes. 6. the mutation rate was relatively high. There were two mutation patterns: S143T and I126S., and the mutation sites were concentrated in 143rd amino acids.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R181.3

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