本文選題：丙型肝炎病毒 + 危險因素　； 參考：《中國疾病預(yù)防控制中心》2017年碩士論文

【摘要】：丙型肝炎病毒(HCV)是一種嚴(yán)重危害人類健康的病原體,可通過血液及血制品、靜脈注射及母嬰垂直等途徑傳播。HCV感染可導(dǎo)致慢性肝炎、肝硬化甚至肝癌,已對人類健康造成嚴(yán)重危害。目前全球HCV流行率約為2.5%,且地區(qū)間流行率差異顯著。HCV分為6個基因型,100多個亞型,不同亞型HCV常依賴特定的途徑傳播,這也導(dǎo)致了不同地區(qū)、不同人群中HCV流行株基因型存在差異。中國HCV流行現(xiàn)狀并不樂觀。由于資料有限,對于中國一般人群中HCV流行率的報道并不準(zhǔn)確,有報道的中國一般人群中HCV流行率介于0.39%-2.5%。中國丙型肝炎病毒流行株主要有1、2、3、6型,而其中又以1b亞型為主。在北方地區(qū)2a型HCV是僅次于1b型HCV最常見的流行株,而在南方部分省份尤其是長江三角洲地區(qū)和珠江三角洲地區(qū),6a亞型已經(jīng)取代2a亞型成為第二常見的HCV流行株,且新發(fā)6a型HCV感染呈上升趨勢。本研究的研究對象為河北某村。此村為我實驗室丙肝研究現(xiàn)場,我們最早于1994對該村所有人群進(jìn)行了一次橫斷面調(diào)查,之后又分別于2005年和2014年對該村村民進(jìn)行過血清學(xué)調(diào)查。對該村HCV患者長期動態(tài)的觀察對于HCV自然史的研究具有重要意義。本研究的目的是了解河北某村HCV感染情況,探尋該村HCV傳播的原因,推斷該村村民HCV感染的危險因素,為HCV的防控及HCV感染者的管理提供基礎(chǔ)資料。本研究總共分為兩部分。第一部分是對該村人群進(jìn)行的橫斷面調(diào)查,利用統(tǒng)計學(xué)方法推斷該村村民HCV感染的危險因素。本部分研究使用1994年獲得的數(shù)據(jù),首先對危險因素進(jìn)行l(wèi)ogistic單因素檢驗,有統(tǒng)計學(xué)意義的變量再進(jìn)行多因素logistic回歸分析。研究發(fā)現(xiàn),僅獻(xiàn)血漿史(OR=26.214)、混合獻(xiàn)血史(OR=11.397)以及獻(xiàn)血漿年數(shù)(OR=1.182)為該村村民HCV感染的危險因素,我們推測20世紀(jì)80-90年代的非法采血活動是導(dǎo)致該村HCV流行的原因。第二部分是分子流行病學(xué)研究,利用生物信息學(xué)方法對獲得的HCV RNA序列進(jìn)行分析,了解該村HCV基因型的分布,推斷該村HCV起源。我們選用2014年獲得的血清標(biāo)本,抽提RNA并采用巢式PCR的方法獲得C-E1區(qū)和NS5B區(qū)序列,測序。系統(tǒng)發(fā)生分析發(fā)現(xiàn)該村僅存在1b、2a兩種亞型的HCV,1b為主要流行亞型(75%)。分子進(jìn)化分析發(fā)現(xiàn)1b型HCV起源復(fù)雜多樣,2a型HCV來源較單一。MCC樹及BSP曲線圖顯示該村HCV感染爆發(fā)時期約為1985～1995年間,與中國中部地區(qū)非法采血活動盛行的時間相符,推斷由于村民參與非法采血活動而導(dǎo)致了 HCV在該村的傳播流行。綜上所述,興盛于80年代末至90年代初的非法采血活動導(dǎo)致了該村HCV的流行,加強(qiáng)血制品管理,規(guī)范采血活動,嚴(yán)格篩選獻(xiàn)血員對于HCV的防控具有重要意義。
[Abstract]:Hepatitis C virus (HCV) is a serious human health pathogen, which can be transmitted by blood and blood products, intravenous injection and vertical transmission of mother and child. HCV infection can lead to chronic hepatitis, liver cirrhosis and even liver cancer. Has caused serious harm to human health. At present, the global prevalence of HCV is about 2.5%, and there are significant differences between regions. There are more than 100 subtypes of HCV genotypes. Different subtypes of HCV often rely on specific routes for transmission, which leads to different regions. The genotypes of HCV epidemic strains were different in different populations. The prevalence of HCV in China is not optimistic. Because of the limited data, the report on the prevalence rate of HCV in the general population of China is not accurate. The reported prevalence rate of HCV in the general population of China is between 0.39 and 2.5. The main epidemic strains of hepatitis C virus in China are 1B subtype and 1b subtype. Type 2a HCV is the most common epidemic strain after type 1b HCV in northern China, while subtype 2a has replaced 2a subtype as the second most common prevalent strain of HCV in some southern provinces, especially in the Yangtze River Delta and the Pearl River Delta. The new type 6 a HCV infection showed an increasing trend. The research object of this study is a village in Hebei province. This village is the site of hepatitis C research in our laboratory. We first carried out a cross-sectional survey of all the people in the village in 1994, and then carried out serological investigation on the villagers in 2005 and 2014 respectively. Long-term dynamic observation of HCV patients in this village is of great significance to the study of HCV natural history. The purpose of this study was to understand the situation of HCV infection in a village in Hebei province, to find out the causes of HCV transmission in this village, to infer the risk factors of HCV infection in the village, and to provide basic information for the prevention and control of HCV and the management of HCV infection. This study is divided into two parts. The first part is a cross-sectional survey of the village population, using statistical methods to infer the risk factors of HCV infection. In this part, the data obtained in 1994 were used to test the risk factors by logistic single factor test, and then multivariate logistic regression analysis was carried out on the statistically significant variables. It was found that the risk factors of HCV infection in the village were only the plasma donation of ORX 26.214m and the mixed blood donation history of 11.397). We speculated that the illegal blood collection activity in the 80-90 's was the cause of the epidemic of HCV in this village. The second part is molecular epidemiology study. The HCV RNA sequence was analyzed by bioinformatics method, and the distribution of HCV genotypes in the village was understood, and the origin of HCV was inferred. We selected the serum samples obtained in 2014, extracted RNA and obtained the sequence of C-E1 region and NS5B region by nested PCR, and sequenced them. Phylogenetic analysis showed that there were only two subtypes of HCV1b in this village. Molecular evolution analysis showed that the origin of 1b type HCV was more complex and diverse than that of single HCV source. MCC tree and BSP curve showed that the outbreak period of HCV infection in this village was about 1985 / 1995, which was consistent with the time of illegal blood collection in central China. It is inferred that the spread of HCV in the village was caused by villagers' participation in illegal blood collection activities. To sum up, the illegal blood collection activities that flourished from the late 1980s to the early 1990s led to the prevalence of HCV in the village. It is of great significance to strengthen the management of blood products, standardize the blood collection activities and strictly screen blood donors for the prevention and control of HCV.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.63;R181.3

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