摘要
目的 分析山东省人群戊型肝炎流行现状,为戊型肝炎防控提供参考.方法 于2014年10月,在山东省12个县（市、区）采用两阶段分层随机抽样方法,选取1-59岁常住人口作为调查对象.首先采用概率比例规模抽样法在调查县（市、区）抽取2个行政村/社区居委会,按照最适分配分层随机抽样方法抽取1-59岁人群,开展问卷调查并采集静脉血标本3-5 ml,共5229名.采用ELISA法检测戊型肝炎病毒（HEV）IgG抗体（抗-HEV IgG）;采用抽样权重进行复杂抽样的抗-HEV IgG阳性率点值估计,采用泰勒级数线性法估计抗-HEV IgG阳性率的方差,然后构建估计值的95%CI.通过比较率点值的95%CI进行率的统计学检验.并与2006年山东省戊型肝炎血清流行病学调查结果相比较.结果 5229名调查对象的抗-HEV IgG阳性率为9.19%（95%CI：6.18%-12.20%）,较2006年调查结果（11.47%,95%CI：8.92%-14.02%）下降19.88%;抗-HEV IgG阳性率随年龄增加而增高（χ2趋势=288.11,P〈0.001）,与2006年趋势相同.除1-4岁年龄组抗-HEV IgG与2006年基本持平外,其余各年龄组阳性率均低于2006年相应年龄组.2014年山东省城市人群抗-HEV IgG阳性率（8.19%,95%CI：0.00-22.23%）低于农村（9.69%,95%CI：4.99%-14.38%）,东部（12.70%,95%CI：0.00-27.72%）高于中部（4.74%,95%CI：0.00-9.91%）和西部（9.32%,95%CI：0.69%-17.94%）,且以上地区抗-HEV IgG阳性率均低于2006年相应地区（11.39%,95%CI：8.17%-14.62%;11.92%,95%CI：8.75%-15.08%;22.77%,95%CI：14.99%-30.55%;7.97%,95%CI：4.75%-11.20%;10.59%,95%CI：6.37%-14.82%）.2014年沿海（16.56%,95%CI：12.94%-20.18%）、内陆（7.63%,95%CI：5.16%-10.10%）人群抗-HEV IgG阳性率均低于2006年（28.04%,95%CI：20.45%-35.64%;9.50%,95%CI：7.31%-11.70%）.2014年,农民（11.98%,95%CI：8.20%-15.76%）、工人（9.68%,95%CI：4.48%-14.88%）、干部（13.90%,95%CI：7.47%-20.33%）、公共场所服务人员（12.26%,95%CI：1.80%-22.73%）,抗-HEV IgG阳性率亦均低于2006年调查相应人群（13.76%,95%CI：10.15%-17.38%;21.11%,95%CI：12.67%-29.55%;17.81%,95%CI：7.63%-28.00%;21.08%,95%CI：0.03%-42.12%）.结论 近年来山东省自然人群戊型肝炎阳性率有所下降,但流行特征未发生明显变化;人群易感性较高,应在高危人群中推广使用戊型肝炎疫苗.
Objective To analyze the sero-epidemiological characteristics of hepatitis E virus （HEV） in Shandong province, and thereby to provide evidence for the policy-making of hepatitis E prevention and control. Methods The inhabitants aged between 1-59 years old were randomly selected to participate in the study by two-stage stratified random sampling method from 12 counties in Shandong province in October, 2014. Firstly two townships were selected from each county by probability proportional to size sampling （PPS） method. A total of 5229 participants aged 1-59 years old were selected by stratified random sampling method. All the participants finished a questionnaire survey and a venous blood sample （3-5 ml） was collected from each to test anti-HEV IgG by enzyme-linked assay （ELISA）. The weighted prevalence of anti-HEV IgG with different demographic characteristics was estimated. The variance of the positive rate of anti-HEV IgG was calculated by Taylor series linearization method, as well as its 95%CI. A statistical test was conducted to compare the rate of its 95%CI, and the results in the present study were compared with those in sero-survey in 2006. Results A total of 5229 subjects entered the final analysis in 2014. The overall weighed prevalence of anti-HEV IgG was 9.19% （95%CI： 6.18%-12.20%） among natural population in Shandong province, decreased by 19.88% in comparison with that in 2006 sero-survey （11.47%,95%CI： 8.92%-14.02%）. The prevalence increased with age increasing（χ2trend=288.11,P〈0.001）in 2014, which was similar to the result in 2006 sero-survey. Except for 1-4 years old group, the prevalence of anti-HEV IgG in the other age groups were lower than it in the corresponding groups in 2006. The prevalence of anti-HEV IgG in urban （8.19%, 95%CI：0.00-22.23%）, rural areas （9.69%, 95%CI：4.99%-14.38%）, eastern areas （12.70%, 95%CI： 0.00-27.72%）, central areas （4.74%, 95%CI： 0.00-9.91%） and western areas （9.32%, 95%CI：0.69%-17.94%） in 2014 were all lower than the corresponding prevalences （11.39%, 95%CI： 8.17%-14.62%; 11.92%, 95%CI： 8.75%-15.08%; 22.77%, 95%CI： 14.99%-30.55%; 7.97%, 95%CI： 4.75%-11.20%;10.59%, 95%CI：6.37%-14.82%） in 2006 survey. The prevalence of anti-HEV IgG in coastal areas （16.56%, 95%CI：12.94%-20.18%） and inland areas （7.63%,95%CI：5.16%-10.10%）in 2014 were lower than it in the corresponding areas （28.04%, 95%CI：20.45%-35.64%;9.50%, 95%CI：7.31%-11.70%）in 2006 survey. The prevalence among peasant （11.98%, 95%CI： 8.20%-15.76%）, worker （9.68%, 95%CI：4.48%-14.88%）, cadre （13.90%, 95%CI： 7.47%-20.33%）, service provider （12.26%, 95%CI： 1.80%-22.73%） in 2014 survey were lower than it among the corresponding populations （13.76%, 95%CI：10.15%-17.38%;21.11%, 95%CI：12.67%-29.55%;17.81%, 95%CI：7.63%-28.00%;21.08%, 95%CI：0.03%-42.12%） in 2006 survey. Conclusion The prevalence of anti-HEV IgG has decreased in Shandong province in the recent years, but the epidemiological characteristics found no obvious changes. HEV susceptibility in natural population was generally high. Hepatitis E vaccines were recommended to be used in HEV high-risk population in the province.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2017年第7期587-592,共6页
Chinese Journal of Preventive Medicine
基金
山东省医药卫生科技发展计划（2016WS0386）
山东省泰山学者工程（ts201511105）
