家族性乙型肝炎的感染途径及其对临床转归的影响

摘要

Objective To investigate the infection route of familial hepatitis B and the impact factors on clinical outcomes.Methods Totally 279 patients with familial hepatitis B and their relatives was retrospectively observed.Results The percentage of hepatitis B virus-infected mothers was 46.6％ (130/279) ; most of the cases were natural childbirth and 97.2％ (70/72)of parents did not take blocking methods.The children hepatitis B virus infection rate was increased,especially with the parents who were over 40 years old; the infection rate was 92.9％ (92/99) (x2 =39.545,P ＜0.01).The age of 40 years or older had a higher prevalence of disease.In the patients of end-stage liver disease such as cirrhosis and liver cancer,the proportion of HBeAg positive was reduced [cirrhosis was 38.2％ (34/89),liver cancer was 18.2％ (8/44),x2 =11.353,P ＜ 0.05] and hepatitis B virus positive rate was increased[cirrhosis was 52.8％ (47/89) ; liver cancer was 56.8％ (25/44)] (x2 =5.300,P ＜0.05).Conclusions Route of infection of familial hepatitis B infection is still mainly mother-to-child transmission and the main reason of infection is no blocking measures.Aggressive antiviral treatment can delay the progression of the disease and improve the prognosis of patients.%目的 探讨家族性乙型肝炎的感染途径及其对临床转归的影响.方法 采用流行病学研究方法,对279例家族性乙型肝炎感染者当面或电话询问,了解其乙型肝炎病毒(HBV)的感染途径、治疗及病情进展等情况,并对相关指标进行统计分析.结果 279例HBV感染者中母亲单方为HBV感染者占46.6％ (130/279),母亲以自然分娩为主,97.2％(70/72)没有采取阻断措施.随着父母年龄的增长,其子女HBV的感染率增加,尤其是40岁以上的父母,感染率为92.9％ (92/99) (x2=39.545,P＜0.01).抗病毒的进展率较未抗病毒的患者的疾病进展率明显降低,差异有统计学意义[25.0％(24/96)比38.8％ (71/183),x2=5.338,P＜0.05].年龄在40岁以上的患者容易发生疾病进展.终末期肝病——乙型肝炎肝硬化、肝癌患者中,随着疾病进展,HBVe抗原(HBeAg)阳性比例减少[肝硬化38.2％(34/89)、肝癌18.2％(8/44)] (x2=11.353,P＜0.05),HBV-DNA阳性比例增加[肝硬化52.8％ (47/89)、肝癌56.8％ (25/44)](x2=5.300,P＜0.05).结论 家族性乙型肝炎的感染途径仍以母婴为主,没有采取阻断措施可能是其高感染率的主要原因;抗病毒治疗可以延缓疾病的进展、有效改善患者的预后;此外还应关注以HBeAg阴性、HBV-DNA阴性感染模式的乙型肝炎终末期肝病研究.