兰州市血液透析患者乙型肝炎病毒感染的危险因素
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摘要
目的探讨兰州市血液透析患者乙型肝炎病毒(Hepatitis B virus,HBV)感染的危险因素。方法对兰州市五家医院血透门诊血透患者问卷调查,收集患者一般人口学资料、既往病史、血液透析过程相关因素、HBV病毒感染检测资料,对数据进行单因素及广义估计方程模型分析。结果共调查565例血液透析患者,其中HBV阳性31例,感染率为5.49%。广义估计方程模型分析显示使用血液制品(1 998年以前OR=8.077,95%CI:3.469～18.803;1998年以后OR=2.678,95%CI:1.719～4.170)、输血(1 998年以前OR=5.344,95%CI:2.212～12.910)、透析龄/月(OR=1.008,95%CI:1.002～1.014)、创伤性美容(OR=1.954,95%CI:1.015～3.766)、文化程度低(OR=3.564,95%CI:1.881～6.753)使透析患者感染HBV的风险提高;年龄>40岁(OR=0.214,95%CI:0.064～0.712)的血液透析患者相对于25岁以下患者乙型肝炎病毒表面抗原(hepatitis B surface antigen, HBsAg)阳性率较低。结论使用血液制品、输血、透析龄越长、创伤性美容和文化程度低能增加血透患者感染HBV风险,在临床中应格外重视血液和血液制品管理和使用,规范透析操作,加强乙型肝炎防治宣传工作。
Objective To explore the risk factors of hepatitis B virus infection in hemodialysis patients. Methods The patients in hemodialysis center of five hospitals in Lanzhou were interviewed through a questionnaire survey. The data of social demography, medical history, hemodialysis process and laboratory test of HBV were collected and analyzed by univariate and Generalized Estimating Equation(GEE) model analysis. Results Among total 565 investigated hemodialysis patients, 31 were HBV positive, with the infection rate of 5.49%. The result of GEE analysis indicated that using blood products(before 1998: OR=8.077,95% CI: 3.469-18.803;after 1998: OR=2.678,95% CI: 1.719-4.170), blood transfusion(before 1998: OR=5.344,95% CI: 2.212-12.910), dialysis time(OR=1.008, 95% CI: 1.002-1.014), surgical cosmetology(OR=1.954, 95% CI: 1.015-3.766) and poor educational background(OR=3.564, 95% CI: 1.881-6.753) were risk factors of HBV infection in hemodialysis patients. Compared to hemodialysis patients aged 25 years old and younger, those aged 40 years(OR=0.214,95% CI:0.064-0.712) and above had a lower HBsAg positive rate. Conclusions Using blood products, blood transfusion before 1998, dialysis time, surgical cosmetology and poor educational background can increase the risk of HBV infection; poor educational background increases the risk of HBV infection in the hemodialysis patients. More attention should be paid on the management and usage of blood and blood products in clinical treatment. Dialysis operation should be standardized and propaganda of HBV prevention should be strengthened.
Objective To explore the risk factors of hepatitis B virus infection in hemodialysis patients. Methods The patients in hemodialysis center of five hospitals in Lanzhou were interviewed through a questionnaire survey. The data of social demography, medical history, hemodialysis process and laboratory test of HBV were collected and analyzed by univariate and Generalized Estimating Equation(GEE) model analysis. Results Among total 565 investigated hemodialysis patients, 31 were HBV positive, with the infection rate of 5.49%. The result of GEE analysis indicated that using blood products(before 1998: OR=8.077,95% CI: 3.469-18.803;after 1998: OR=2.678,95% CI: 1.719-4.170), blood transfusion(before 1998: OR=5.344,95% CI: 2.212-12.910), dialysis time(OR=1.008, 95% CI: 1.002-1.014), surgical cosmetology(OR=1.954, 95% CI: 1.015-3.766) and poor educational background(OR=3.564, 95% CI: 1.881-6.753) were risk factors of HBV infection in hemodialysis patients. Compared to hemodialysis patients aged 25 years old and younger, those aged 40 years(OR=0.214,95% CI:0.064-0.712) and above had a lower HBsAg positive rate. Conclusions Using blood products, blood transfusion before 1998, dialysis time, surgical cosmetology and poor educational background can increase the risk of HBV infection; poor educational background increases the risk of HBV infection in the hemodialysis patients. More attention should be paid on the management and usage of blood and blood products in clinical treatment. Dialysis operation should be standardized and propaganda of HBV prevention should be strengthened.
引文
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[2] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南2010年版[J].胃肠病学,2011,16(6):351-366.DOI:10.3969/j.issn.1008-7125.2011.06.009.Chinses Society Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 Version)[J].Chin J Gastroenter,2011,16(6):351-366.DOI:10.3969/j.issn.1008-7125.2011.06.009.
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[5] 李慧,高丽,张晓曙,等.甘肃省1～59岁人群乙型肝炎病毒感染的血清流行病学调查[J].微生物学免疫学进展,2010,38(1):50-54.DOI:10.13309/j.cnki.pmi.2010.01.018.Li H,Gao L,Zhang XS,et al.Seroepidemiological research of infective status of hepatitis B virus among people aged 1-59 years old in gansu province[J].Prog in Microbiol Immunol,2010,38(1):50-54.DOI:10.13309/j.cnki.pmi.2010.01.018.
[6] 邹杨,温玉,蒲蕾,等.四川省新增血液透析患者的流行病学调查(2011-2016年)[J].肾脏病与透析肾移植杂志,2018,27(4):311-314,395.DOI:10.3969/j.issn.1006-298X.2018.04.003.Zhou Y,Wen Y,Pu L,et al.Epidemiology of initial hemodialysis patients in sichuan province during 2011-2016[J].J Nephrol Dialy Transplant,2018,27(4):311-314,395.DOI:10.3969/j.issn.1006-298X.2018.04.003.
[7] 闫国胜,赵显国,李素珍,等.河南省血液透析患者原发病与流行病学调查[J].中国血液净化,2008,7(9):483-484,487.Yan GS,Zhao XG,Li SZ,et al.Etiology and epidemiology investigation of hemodialysis patients in henan province[J].Chin J Blood Purif,2008,7(9):483-484,487.
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[9] 张晓华,李静,王利华.近5年维持性血液透析患者的流行病学调查分析[J].中国血液净化,2015,14(11):698-702.DOI:10.3969/j.issn.1671-4091.2015.11.015 Zhang XH,Li J,Wang LH.Epidemiological analysis of the maintenance hemodialysis patients over the past 5 years[J].Chin J Blood Purif,2015,14(11):698-702.DOI:10.3969/j.issn.1671-4091.2015.11.015.
[10] 张伟明,钱家麒.上海市透析登记及其结果分析[J].中国血液净化,2012,11(5):233-236.DOI:10.3969/j.issn.1671-4091.2012.05.001.Zhang WM,Qian JQ.Current status of dialysis therapy in shanghai(results from shanghai renal registry,2011)[J].Chin J Blood Purif,2012,11(5):233-236.DOI:10.3969/j.issn.1671-4091.2012.05.001.
[11] 冯旭,叶贤林.乙型肝炎病毒输血感染影响因素研究进展 [J].中国输血杂志,2014,27(2):212-215.DOI:10.13303/j.cjbt.issn.1004-549x.2014.02.0041.Feng X,Ye XL.Infectivity of hepatitis B virus infection in blood transfusion [J].Chin J Blood Transfusion Feb,2014,27(2):212-215.DOI:10.13303/j.cjbt.issn.1004-549x.2014.02.0041.
[12] 王笃初,谭德明,曹希娟.输血后乙型肝炎病毒感染的前瞻性研究 [J].中华实验和临床病毒学杂志,2000,14(1):77-79.Wang DC,Tan DM,Cao XJ.A prospective study of posttransfusion hepatitis B virus infection [J].Chinese J Exp Clin Virol,2000,14(1):77-79.
[13] 张涛,廖红梅,张春红,等.重庆地区无偿献血人群隐匿性乙型肝炎病毒感染的特征 [J].传染病信息,2017,30(1):44-47.DOI:10.3969/j.issn.1007-8134.2017.01.014.Zhang T,Liao HM,Zhang CH,et al.Characterization of occult hepatitis B virus infection in chongqing unpaid blood donors [J].Infect Dis Info,2017,30(1):44-47.DOI:10.3969/j.issn.1007-8134.2017.01.014.
[14] 徐艺,张少白,李平,等.陕西省乙型肝炎病毒感染及影响因素分析 [J].中国公共卫生,2009,25(12):1501-1502.Xu Y,Zhang SB,Li P,et al.Infective status of hepatitis B virus and its influence factors in shaanxi province [J].Chin J Public Health,2009,25(12):1501-1502.
[15] 陈园生,李放军,王晓军,等.公共服务场所乙型肝炎病毒感染危险性研究 [J].中华流行病学杂志,2008,29(7):689-692.Chen YS,Li Fang J,Wang XJ,et al.Study of the risk of HBV infection in the public service place [J] Chin J Epidemiol,2008,29(7):689-692.
[16] 刘强,姚丽,刘晓丹,等.维持性血液透析患者病毒性肝炎感染分析 [J].中国血液净化,2012,11(8):417-420.DOI:10.3969/j.issn.1671-4091.2012.08.004.Liu Q,Yao L,Liu XD,et al.Analysis of virus hepatitis infection in maintenance hemodialysis patients [J].Chin J Blood Purif,2012,11(8):417-420.DOI:10.3969/j.issn.1671-4091.2012.08.004.
[17] 王婉馨,匡莉,王海银.广州市终末期肾病患者血液透析服务需求调查 [J].中华疾病控制杂志,2015,19(9):934-937.DOI:10.16462/j.cnki.zhijbkz.2015.09.019.Wang WX,Kuang L,Wang HY.An investigation on the service requirement of end stage renal disease patients with hemodialysis in guangzhou city [J].Chin J Dis Control Prev,2015,19(9):934-937.DOI:10.16462/j.cnki.zhijbkz.2015,09.019.
[18] 湛柳华,黄丽娟,周文,等.广州市社区居民病毒性肝炎血清流行病学调查及相关影响因素分析 [J].华南预防医学,2012,38(3):18-21.Zhan LH,Huang LJ,Zhou W,et al.Seroepidemiologic study of viral hepatitis and its risk factors among residents in guangzhou City [J].South China J Prev Med,2012,38(3):18-21.
[2] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南2010年版[J].胃肠病学,2011,16(6):351-366.DOI:10.3969/j.issn.1008-7125.2011.06.009.Chinses Society Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 Version)[J].Chin J Gastroenter,2011,16(6):351-366.DOI:10.3969/j.issn.1008-7125.2011.06.009.
[3] Wang C,Sun J,Zhu B,et al.Hepatitis B virus infection and related factors in hemodialysis patients in China-systematic review and meta-analysis[J].Ren Fail,2010,32(10):1255-1264.DOI:10.3109/0886022x.2010.517354.
[4] 中国卫生部.WS299-2008 乙型病毒性肝炎诊断标准[S].中国卫生部传染病标准专业委员会.北京:中国标准出版社,2008.Ministry of public health of China.WS299-2008 diagnostic criteria for hepatitis B viral [S] ministry of health infectious disease standard professional committee of China.Beijing:standards press of china,2008.
[5] 李慧,高丽,张晓曙,等.甘肃省1～59岁人群乙型肝炎病毒感染的血清流行病学调查[J].微生物学免疫学进展,2010,38(1):50-54.DOI:10.13309/j.cnki.pmi.2010.01.018.Li H,Gao L,Zhang XS,et al.Seroepidemiological research of infective status of hepatitis B virus among people aged 1-59 years old in gansu province[J].Prog in Microbiol Immunol,2010,38(1):50-54.DOI:10.13309/j.cnki.pmi.2010.01.018.
[6] 邹杨,温玉,蒲蕾,等.四川省新增血液透析患者的流行病学调查(2011-2016年)[J].肾脏病与透析肾移植杂志,2018,27(4):311-314,395.DOI:10.3969/j.issn.1006-298X.2018.04.003.Zhou Y,Wen Y,Pu L,et al.Epidemiology of initial hemodialysis patients in sichuan province during 2011-2016[J].J Nephrol Dialy Transplant,2018,27(4):311-314,395.DOI:10.3969/j.issn.1006-298X.2018.04.003.
[7] 闫国胜,赵显国,李素珍,等.河南省血液透析患者原发病与流行病学调查[J].中国血液净化,2008,7(9):483-484,487.Yan GS,Zhao XG,Li SZ,et al.Etiology and epidemiology investigation of hemodialysis patients in henan province[J].Chin J Blood Purif,2008,7(9):483-484,487.
[8] Su Y,Yan R,Duan Z,et al.Prevalence and risk factors of hepatitis C and B virus infections in hemodialysis patients and their spouses:a multicenter study in Beijing,China[J].J Med Virol,2013,85(3):425-432.DOI:10.1002/jmv.23486.
[9] 张晓华,李静,王利华.近5年维持性血液透析患者的流行病学调查分析[J].中国血液净化,2015,14(11):698-702.DOI:10.3969/j.issn.1671-4091.2015.11.015 Zhang XH,Li J,Wang LH.Epidemiological analysis of the maintenance hemodialysis patients over the past 5 years[J].Chin J Blood Purif,2015,14(11):698-702.DOI:10.3969/j.issn.1671-4091.2015.11.015.
[10] 张伟明,钱家麒.上海市透析登记及其结果分析[J].中国血液净化,2012,11(5):233-236.DOI:10.3969/j.issn.1671-4091.2012.05.001.Zhang WM,Qian JQ.Current status of dialysis therapy in shanghai(results from shanghai renal registry,2011)[J].Chin J Blood Purif,2012,11(5):233-236.DOI:10.3969/j.issn.1671-4091.2012.05.001.
[11] 冯旭,叶贤林.乙型肝炎病毒输血感染影响因素研究进展 [J].中国输血杂志,2014,27(2):212-215.DOI:10.13303/j.cjbt.issn.1004-549x.2014.02.0041.Feng X,Ye XL.Infectivity of hepatitis B virus infection in blood transfusion [J].Chin J Blood Transfusion Feb,2014,27(2):212-215.DOI:10.13303/j.cjbt.issn.1004-549x.2014.02.0041.
[12] 王笃初,谭德明,曹希娟.输血后乙型肝炎病毒感染的前瞻性研究 [J].中华实验和临床病毒学杂志,2000,14(1):77-79.Wang DC,Tan DM,Cao XJ.A prospective study of posttransfusion hepatitis B virus infection [J].Chinese J Exp Clin Virol,2000,14(1):77-79.
[13] 张涛,廖红梅,张春红,等.重庆地区无偿献血人群隐匿性乙型肝炎病毒感染的特征 [J].传染病信息,2017,30(1):44-47.DOI:10.3969/j.issn.1007-8134.2017.01.014.Zhang T,Liao HM,Zhang CH,et al.Characterization of occult hepatitis B virus infection in chongqing unpaid blood donors [J].Infect Dis Info,2017,30(1):44-47.DOI:10.3969/j.issn.1007-8134.2017.01.014.
[14] 徐艺,张少白,李平,等.陕西省乙型肝炎病毒感染及影响因素分析 [J].中国公共卫生,2009,25(12):1501-1502.Xu Y,Zhang SB,Li P,et al.Infective status of hepatitis B virus and its influence factors in shaanxi province [J].Chin J Public Health,2009,25(12):1501-1502.
[15] 陈园生,李放军,王晓军,等.公共服务场所乙型肝炎病毒感染危险性研究 [J].中华流行病学杂志,2008,29(7):689-692.Chen YS,Li Fang J,Wang XJ,et al.Study of the risk of HBV infection in the public service place [J] Chin J Epidemiol,2008,29(7):689-692.
[16] 刘强,姚丽,刘晓丹,等.维持性血液透析患者病毒性肝炎感染分析 [J].中国血液净化,2012,11(8):417-420.DOI:10.3969/j.issn.1671-4091.2012.08.004.Liu Q,Yao L,Liu XD,et al.Analysis of virus hepatitis infection in maintenance hemodialysis patients [J].Chin J Blood Purif,2012,11(8):417-420.DOI:10.3969/j.issn.1671-4091.2012.08.004.
[17] 王婉馨,匡莉,王海银.广州市终末期肾病患者血液透析服务需求调查 [J].中华疾病控制杂志,2015,19(9):934-937.DOI:10.16462/j.cnki.zhijbkz.2015.09.019.Wang WX,Kuang L,Wang HY.An investigation on the service requirement of end stage renal disease patients with hemodialysis in guangzhou city [J].Chin J Dis Control Prev,2015,19(9):934-937.DOI:10.16462/j.cnki.zhijbkz.2015,09.019.
[18] 湛柳华,黄丽娟,周文,等.广州市社区居民病毒性肝炎血清流行病学调查及相关影响因素分析 [J].华南预防医学,2012,38(3):18-21.Zhan LH,Huang LJ,Zhou W,et al.Seroepidemiologic study of viral hepatitis and its risk factors among residents in guangzhou City [J].South China J Prev Med,2012,38(3):18-21.