本文關(guān)鍵詞：江蘇省一般人群乙型肝炎病毒感染現(xiàn)況及其影響因素的研究　出處：《南京醫(yī)科大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 乙型肝炎 表面抗原 陽性率 HBV感染 酶聯(lián)免疫吸附法 化學(xué)發(fā)光微粒子免疫法

【摘要】：目的:(1)調(diào)查分析江蘇省張家港、丹陽和泰興三個縣(市)一般人群乙型肝炎病毒(Hepatitis B Virus, HBV)表面抗原(HBsAg)陽性率,研究一般人群慢性HBV感染的流行特征,并分析其相關(guān)影響因素,為進(jìn)一步采取有針對性干預(yù)措施,提高乙型病毒性肝炎綜合防治水平提供依據(jù)。(2)通過乙型肝炎病毒表面抗原(HBsAg)、表面抗體(Anti-HBs)和核心抗體(Anti-HBc)三項指標(biāo)的檢測,分析一般人群中乙型病毒性肝炎感染現(xiàn)狀,為指導(dǎo)采取適宜的乙型病毒性肝炎免疫策略,降低全人群的乙型病毒性肝炎感染率提供科學(xué)依據(jù)。(3)比較國產(chǎn)酶聯(lián)免疫吸附試驗試劑與雅培化學(xué)發(fā)光微粒子免疫分析法檢測HBsAg與Anti-HBs的結(jié)果,評價國產(chǎn)酶聯(lián)免疫吸附試驗試劑在乙肝慢性感染率或人群免疫水平調(diào)查中的應(yīng)用價值。 方法:(1)采用分地區(qū)整群隨機抽樣的方法確定調(diào)查對象,開展問卷調(diào)查、采集靜脈血、檢測HBsAg,采用單因素和多因素Logistic回歸方法對HBsAg陽性相關(guān)影響因素進(jìn)行分析。(2)對隨機抽取1936例血清樣本應(yīng)用雅培化學(xué)發(fā)光微粒子免疫分析法進(jìn)行HBsAg、Anti-HBs與Anti-HBc檢測,并與國產(chǎn)酶聯(lián)免疫吸附試驗試劑檢測HBsAg和Anti-HBs進(jìn)行比較,分析國產(chǎn)酶聯(lián)免疫吸附試驗試劑的檢測敏感性和特異性。 結(jié)果:(1)張家港、丹陽和泰興抽樣人群的HBsAg陽性率分別為5.11%、7.83%和9.77%,按2000年全國人口年齡構(gòu)成標(biāo)化后,張家港、丹陽和泰興的HBsAg標(biāo)化陽性率分別為4.32%、6.54%和9.25%。18歲以上計劃免疫前出生人群HBsAg陽性率均顯著高于18歲以下計劃免疫后出生人群,18-40歲年齡段人群HBsAg陽性率有隨年齡升高而升高的趨勢。三個地區(qū)中18歲以上年齡組中接種乙型肝炎疫苗人群的HBsAg陽性率均明顯低于未接種乙肝疫苗人群。男性、住院、紋身、穿刺、共用針具、共用剃刀為乙型病毒性肝炎感染的危險因素,接種乙肝疫苗則是保護(hù)因素,獻(xiàn)血與乙型病毒性肝炎感染有負(fù)相關(guān)關(guān)系。(2)1936例血清樣本乙肝感染流行率的三項指標(biāo)(HBsAg、Anti-HBs、Anti-HBc)檢測結(jié)果顯示,該人群中HBsAg、Anti-HBs和Anti-HBc的陽性率分別為12.45%、60.49%和58.78%。HBV血清學(xué)三項指標(biāo)全陰性者共324例,占16.74%;慢性HBV感染者共221例,占11.41%;對HBV具有保護(hù)性免疫力者共464例,占23.97%;HBV既往感染者共907例,占46.85%。HBV血清學(xué)三項指標(biāo)全陰性者主要集中在15-40歲年齡組,慢性HBV感染率與HBV既往感染率均隨年齡的增長而增加,而對HBV具有保護(hù)性免疫力者則隨年齡的增長而減少。(3)國產(chǎn)酶聯(lián)免疫吸附試驗試劑的檢測敏感性和特異性的檢驗結(jié)果顯示,在HBsAg檢測中,校正配對χ2=26.04,P0.0001,表明本研究所采用的ELSIA法與雅培CMIA法兩種方法檢測結(jié)果存在不同,但兩者kappa值=0.9373,表明ELISA法(HBsAg)與雅培檢測的一致性很強,其靈敏度與特異度分別為88.38%、100%。兩個方法進(jìn)行Anti-HBs檢測時,存在84例的判讀結(jié)果不一致。參照雅培定量檢測結(jié)果為標(biāo)準(zhǔn),ELISA法(Anti-HBs)靈敏度和特異度分別為95.47%、95.95%。 結(jié)論:張家港、丹陽和泰興的乙型肝炎疫苗納入兒童計劃免疫已顯成效,兒童組HBsAg陽性率明顯降低,成人乙型肝炎疫苗接種也可獲得明顯效果。因此,在完善兒童乙肝計劃免疫的同時,應(yīng)抓緊成人乙肝免疫策略研究。乙肝感染的危險因素還普遍存在,在成人中乙肝感染的狀況依然嚴(yán)峻,不斷加強乙肝防治知識的宣傳教育,提高群眾預(yù)防乙肝感染的能力。國產(chǎn)HBsAg酶聯(lián)免疫吸附試驗試劑特異度高,一般不會誤診,但有一定的漏診率,可滿足一般人群慢性感染者的流行病學(xué)調(diào)查,而Anti-HBs酶聯(lián)免疫吸附試驗試劑的靈敏度和特異性還有待進(jìn)一步提高。
[Abstract]:Objective: (1) the investigation and analysis of Jiangsu province Zhangjiagang, Danyang and Taixing three counties (city) the general population of hepatitis B virus (Hepatitis B, Virus, HBV) surface antigen (HBsAg) positive rate, epidemiological characteristics of chronic HBV infection in the general population, and analyze the related factors, to take further intervention measures targeted to provide the basis for improving the level of prevention and treatment of hepatitis B virus. (2) by hepatitis B virus surface antigen (HBsAg), surface antibody (Anti-HBs) and core antibody (Anti-HBc) detection of the three indicators, analysis of the status quo of hepatitis virus infections in the general population, take appropriate immunization strategy for hepatitis B virus B as a guide, to provide a scientific basis to reduce the rate of hepatitis B virus infection. The total population (3) to compare the ELISA reagent and Abbott chemiluminescence microparticle immunoassay for detection of HBsAg and Anti-HBs. To evaluate the application value of domestic enzyme linked immunosorbent test reagents in the investigation of chronic hepatitis B infection rate or population immunity level.
Methods: (1) using the method of regional cluster random sampling to determine the survey, conducted a questionnaire survey, collected venous blood to detect HBsAg by Logistic univariate and multivariate analysis of factors influencing HBsAg positive regression method. (2) the HBsAg of randomly selected 1936 cases of serum samples by Abbott chemiluminescence microparticle immunohistochemical analysis of Anti-HBs and Anti-HBc detection, and domestic ELISA kit for detection of HBsAg and Anti-HBs were compared. The detection sensitivity and specificity analysis of domestic ELISA kit.
Results: (1) Zhangjiagang, Danyang and Taixing, the positive rate of HBsAg in the sample population were 5.11%, 7.83% and 9.77%, according to the 2000 national population age standardized, Zhangjiagang, Danyang and Taixing HBsAg standard positive rates were 4.32%, 6.54% and 9.25%.18 years old people born before birth plan immune positive rate among HBsAg were significantly higher than those under the age of 18 after immunization, 18-40 HBsAg years old age group the positive rate had increased trend with age. The positive rate of HBsAg age group over 18 years old in the hepatitis B vaccine population in three was significantly lower than that of hepatitis B vaccination groups. Male, hospitalization, tattoo, puncture, sharing needles, razor shared risk factors of hepatitis B infection, hepatitis B vaccination are the protective factors, blood infection and hepatitis B virus were negative correlation. (2) serum samples of HBV infection in 1936 cases The prevalence rate of the three indicators (HBsAg, Anti-HBs, Anti-HBc) test results showed that the HBsAg population, the positive rate of Anti-HBs and Anti-HBc were 12.45%, 60.49% and three indexes of 58.78%.HBV serological negative were 324 cases, accounting for 16.74%; 11.41% for a total of 221 cases of chronic HBV infection; HBV has protection immunity in 464 cases, accounting for 23.97%; the previous HBV infection were 907 cases, accounting for three of all negative serological indicators of 46.85%.HBV mainly concentrated in the 15-40 age group, HBV rate and infection rates were increased significantly with age of chronic HBV infection, while the HBV has the protective immunity is decreased the growth of the age. (3) detection sensitivity and specificity of the results of domestic enzyme-linked immunosorbent assay showed that in HBsAg detection, correction of paired x 2=26.04, P0.0001, showed that the ELSIA method and CMIA method are two Abbott The results are different, but both the value of kappa =0.9373 show that the ELISA method (HBsAg) consistent with Abbott detection is very strong, its sensitivity and specificity were 88.38%, two 100%. method to detect Anti-HBs, there are 84 cases of interpretation of inconsistent results. According to Abbott quantitative detection results for the standard ELISA method (Anti-HBs) the sensitivity and specificity were 95.47%, 95.95%.
Conclusion: Zhangjiagang children's immunization of hepatitis B vaccine has been produced in Danyang and Taixing in children, the positive rate of HBsAg was significantly decreased, adult hepatitis B vaccination can obtain obvious effect. Therefore, to improve the children's hepatitis B immunization program at the same time, should study on hepatitis B immunization strategy. People pay close attention to the risk factors of hepatitis B infection also generally, hepatitis B infection in adults in the situation is still grim, continue to strengthen publicity and education of knowledge of hepatitis B prevention, improve the masses prevention ability of HBV infection. Domestic HBsAg ELISA kit of high specificity, generally not misdiagnosis, but there is a certain rate of missed diagnosis, epidemiological investigation can meet the needs of the general population of chronic infection however, Anti-HBs ELISA reagent sensitivity and specificity remains to be further improved.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R186

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