本文選題：乙型肝炎 + 血清學�。� 參考：《山東大學》2009年碩士論文

【摘要】： 研究背景:乙型病毒性肝炎(簡稱乙肝)是由乙型肝炎病毒(HBV)引起的一種傳染性疾病。HBV可通過多種途徑傳播,主要是經(jīng)輸血和使用血液制品傳播、醫(yī)源性傳播、母嬰傳播和密切接觸傳播等方式。目前沒有治愈乙肝的特效藥,乙肝病程遷延,愈后差,易轉(zhuǎn)變?yōu)槁愿窝住⒏斡不案伟?它是除吸煙以外導致人類癌癥的第二種嚴重的疾病。全世界約20億人曾感染過乙型肝炎病毒(HBV),其中5.5億成為慢性HBV感染者。 我國人群HBV感染率為57.63%,HBsAg攜帶率為9.75%,后者約25%最終轉(zhuǎn)化為慢性肝病,包括肝硬化和原發(fā)性肝細胞癌。我國因慢性乙型肝炎及相關疾病(肝硬化,肝癌)每年造成的直接經(jīng)濟損失高達1122.8億元人民幣。因此,乙型肝炎已成為嚴重威脅人類健康的傳染病,是已知各型病毒性肝炎中危害最嚴重的一個型別,是一個嚴重的公共衛(wèi)生問題,已被WHO列為要加強控制并最終消滅的傳染病。 實踐證明,乙肝的控制如同其它疫苗可預防疾病一樣,通過免疫預防接種,提高易感人群對HBV的免疫力是一種最有效的措施,接種乙肝疫苗是預防和控制乙肝最經(jīng)濟、最有效的手段。1991年,WHO在喀麥隆的雅溫德召開了“發(fā)展中國家控制乙肝的國際會議”,并通過了消除乙肝的“雅溫德宣言”。根據(jù)WHO的建議,凡人群HBsAg陽性率超過5%的國家和地區(qū)應實施全體新生兒乙肝疫苗免疫。為加強我國乙肝的預防控制工作,我國政府采取以兒童乙肝疫苗計劃免疫為主的預防策略,于1992年將乙肝疫苗納入兒童計劃免疫管理,要求所有新生兒均應接種乙肝疫苗,但疫苗及其接種費用需由家長支付;2002年我國又正式將乙肝疫苗納入兒童計劃免疫,由國家財政支持,為所有新生兒免費接種乙肝疫苗。隨著流行病學研究的深入以及其他一些相關因素的改變,乙肝的預防策略應隨之不斷進行調(diào)整,并通過調(diào)查與監(jiān)測的方法對乙肝預防策略的實施效果適時進行評價,根據(jù)調(diào)查與監(jiān)測的結果有助于預防策略的及時調(diào)整。1992年全國病毒性肝炎大規(guī)模調(diào)查距今已有17年之久,為了解包頭市現(xiàn)階段不同地區(qū)、不同人群中乙肝的感染現(xiàn)狀和流行特征,評價長期以來采取的乙肝防制措施效果,特別是實施大規(guī)模乙肝疫苗接種后的效果,為進一步調(diào)整和完善包頭市乙肝的防制措施提供科學依據(jù),配合全國開展的乙肝血清流行病學調(diào)查,按照2008年全國人群乙肝等有關疾病血清學調(diào)查方案在包頭市三所綜合性醫(yī)院開展了本次乙肝病毒感染的血清流行病學門診調(diào)查。 研究目的:通過對包頭市三所綜合性醫(yī)院門診乙肝五項檢測病人的調(diào)查研究,了解包頭市三所綜合醫(yī)院門診病人乙型肝炎病毒(HBV)的感染現(xiàn)狀及流行特征;了解包頭市三所綜合醫(yī)院門診病人乙型肝炎(乙肝)疫苗免疫接種情況:為制定預防和控制乙型肝炎在人群中的傳播和流行的策略和措施提供信息和依據(jù)。 研究方法:(1)抽樣方法:采用分層整群抽樣法。分別不定期抽取2008年6月31日至2009年7月1日期間包頭市三區(qū)(昆都侖區(qū)、青山區(qū)、東河區(qū))內(nèi)三所綜合性醫(yī)院門診血液乙肝五項檢測患者1768名作為研究對象。(2)調(diào)查方法:對每個調(diào)查對象按統(tǒng)一調(diào)查表進行詢問調(diào)查,同時采集靜脈血,分離血清,低溫保存,檢測相關指標。(3)檢測方法:用酶聯(lián)免疫法(ELISA)檢測乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗體(抗-HBs)和乙肝病毒核心抗體(抗-HBc)。(4)統(tǒng)計方法:所有資料錄入EpiData3.1數(shù)據(jù)庫后,用SPSS11.5軟件進行統(tǒng)計處理和分析。 主要結果:(1)人口學特征:調(diào)查對象涉及到不同地區(qū)、年齡、性別、婚姻等。其中城鄉(xiāng)人口比為2.33:1;1～歲、14歲～人群年齡構成比為1:21.33;男女性別比為1:1.60。(2)乙肝疫苗接種情況:包頭市三所綜合醫(yī)院門診做乙肝五項檢測的病人平均乙肝疫苗接種率為53.9%;不同性別、年齡、職業(yè)、文化程度、婚姻狀況、城鄉(xiāng)人群乙肝疫苗接種率經(jīng)統(tǒng)計學檢驗,有顯著性差異:不同民族、肝炎患病史人群乙肝疫苗接種率經(jīng)統(tǒng)計學檢驗無顯著性差異。(3)HBV感染標志血清流行病學特征:包頭市三所綜合醫(yī)院門診病人HBsAg總陽性率為8.5%,且不同性別、不同民族、不同文化程度、不同肝炎患病史的人群的HBsAg陽性率比較顯著性差異;抗-HBs總陽性率為28.5%,且不同職業(yè)、文化程度、婚姻狀況、地區(qū)、肝炎患病史人群的抗-HBs陽性率經(jīng)統(tǒng)計學檢驗有顯著性差異;抗-HBc的總陽性率為8.9%,且不同性別、民族、肝炎患病史的人群其抗-HBc陽性率經(jīng)統(tǒng)計學檢驗有顯著性差異。 結論:本次調(diào)查的人群為包頭市三所綜合醫(yī)院門診乙肝五項檢測患者,其HBsAg陽性率為8.5%,接近乙型肝炎中流行地區(qū)(8%＞HBsAg陽性率≥2%),低于我國人群HBsAg攜帶率(9.75%);其中1992年乙肝疫苗納入兒童計劃免疫管理以后出生的14歲以下兒童HBsAg陽性率發(fā)生顯著下降,而14歲～以上青少年成人組HBsAg陽性率變化不明顯;說明實施大規(guī)模乙肝疫苗接種是控制HBV感染最有效的措施,提示今后在重點做好計劃免疫人群乙肝疫苗接種的同時,還應提高成人乙肝疫苗接種免疫。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R512.62;R181.3

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