本文選題：體檢人群 + 乙型病毒性肝炎��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]通過對云南省2016年某三甲醫(yī)院體檢人群乙肝感染現(xiàn)狀及分子生物流行病學(xué)的調(diào)查研究,了解該醫(yī)院體檢人群乙肝感染現(xiàn)狀,掌握HBsAg陽性率、HBV感染率、HBsAb陽性率以及乙肝兩對半檢出模式、探討基因分型分子生物學(xué)流行病學(xué)特征,為制定有針對性的防控策略和措施提供理論依據(jù),也為云南省乙肝有效控制奠定一定的理論基礎(chǔ)。[方法]運用描述流行病學(xué)方法,對2016年1月1日-12月31日在某三甲醫(yī)院進行健康體檢人群的基本情況,乙肝感染情況,乙肝五項組合模式情況,進行描述性分析。用實驗室檢測技術(shù),包括ELISA檢測、S區(qū)巢式PCR擴增法、基因測序等方法,進行乙肝病毒分子流行病學(xué)研究。[結(jié)果]1.乙肝感染現(xiàn)狀2016年云南省三甲綜合性醫(yī)院進行體檢,并進行乙肝血清五項檢測的人群,37563例,男性22269人,占59.28%,平均年齡46.74±15.72歲;女性15294人,占 40.72%,45.46±15.07。男女比例為 1.46:1。HBsAg 陽性率為 2.91%,男性(3.30%)高于女性(2.35%) (P0.001), 40-49年齡組為陽性率高峰。職業(yè)以其他職業(yè)(4.6%)和生產(chǎn)運輸行業(yè)(4.36%)陽性率較高,。不同民族中彝族(2.99%)和漢族(2.94%)陽性率較高。HBsAb 陽性率為 67.29%,女性(67.94%)高于男性(66.84%) (P0.05),30-39年齡組陽性率最高。不同職業(yè)中科研單位HBsAb陽性率最高(71.62%),企業(yè)單位職員HBsAb陽性率最低(64.26%)。不同民族HBsAb陽性率相同(P=0.082)。HBcAb陽性率為5.69%。男性HBcAb陽性率高于女性(P0.001),陽性率隨年齡增長而上升。職業(yè)中陽性率最高為其它(8.30%),。其他少數(shù)民族(6.21 %)和漢族(5.80%)陽性率最高。HBV感染率為5.71%。男性HBV感染率高于女性(P0.001)。陽性率隨年齡增長而上升。不同職業(yè)中其他職業(yè)感染率最高(7.55%),學(xué)生人群感染率最低(2.99%)。漢族HBV感染率高于其他民族(P0.05)。HBV易感率為29.14%。易感率無性別差異(P0.05)。39歲前易感率隨年齡上升而下降,40歲后易感率隨年齡上升而上升。不同職業(yè)中易感率最高為生產(chǎn)運輸職業(yè)(52.06%),最低為部隊軍人(17.36%)�；刈�(35.07%)和彝族(30.49%)易感率高。2.乙肝血清組合模式乙肝血清五項標記物組合共檢出15種模式。HBsAb單項陽性檢出率最高,占65.14%,血清五項指標全陰模式次之,占29.14%, “小三陽”模式檢出率居第三,占2.39%。在HBV感染的模式中(3、5、6、7、8、9),男性檢出率均高于女性(P0.05)。特殊罕見模式檢出15例�！靶∪枴睓z出率60-69歲組最高(3.32%)且在69歲前檢出率隨年齡增長而上升�！按笕枴睓z出率最高組為20-29歲(0.53%),最低為70歲及以上組(0.06%),其檢出率隨年齡上升而下降。3、乙肝分子流行病學(xué)特征136份經(jīng)檢測HBsAg為陽性的樣本中,115例為小三陽,占84.56%,大三陽8例,占5.88%,HBsAg、HBcAb陽性13例,占9.56%。用巢式PCR兩輪共擴增136份標本,擴增成功17份。其中“大三陽”模式全部測序成功,“小三陽模式”檢出9份。B基因型10例,均為B2亞型;C型7例,其中1例C1型,6例C2型。兩種基因型不同性別檢出情況差異無統(tǒng)計學(xué)意義(P0.05); B基因型中血清型均為adw2型,C基因型中有1例adw2型,6例adr+型。α抗原決定簇突變率為發(fā)現(xiàn)兩種情況I126S有1株,為C基因型,占12.5%,S143T有7株,為B基因型,占87.5%。[結(jié)論]1.云南省2016年某三甲醫(yī)院體檢人群中男性HBsAg陽性率、HBcAb陽性率HBV感染率均高于女性,是乙肝感染的重點人群。2. 40-49歲人群為HBsAg高發(fā)人群。3.職業(yè)不詳人群(家務(wù)及待業(yè)、自由職業(yè)、農(nóng)民等)生產(chǎn)運輸及商業(yè)服務(wù)人群HBsAg陽性率較高。4.乙肝血清組合模式以表面抗體單項陽性為主,五項全陰次之,感染模式以“小三陽”為主。5.檢出B型和C型兩種基因型,亞型為B2和C2型,adw2和adr+兩種血清亞型與B、C基因型顯著相關(guān)。6.本次檢出突變率較高,有兩種突變模式:S143T和I126S。且變異位點集中于第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.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62;R181.3

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