成人急性乙型肝炎临床流行病学特征分析

摘要

Objective To analyze the epidemiological features of acute hepatitis B in adult patients in order to offer advice for the prevention and treatment of adult acute hepatitis B.Methods One hundred and nine patients with acute hepatitis B in our hospital from Jan.2009 to Dec.2012 were enrolled.Data of these cases (e.g.the epidemiological data, serum HBV markers,liver function and clinical outcome)were analyzed retrospectively.Results Most patients were males,for the male and female ratio was 5.06:1 .The major patients were at age from 20 to 59,accounting for 93.57%. Most patients didn't have received hepatitis B vaccine or a quite clear history of vaccination (96.34%).Sexual contact transmission (24.77%)was one of the important ways,with a total of 27 cases.Incidence of adult acute hepatitis B had been on the rise year by year.Liver function of patients in the early stage was impaired severely.For most patients,acute hepatitis B began with acute jaundice,and had long course with favourable prognosis at the rate of 94.50%.The anti-HBc IgM level in all patients on admission was 20.38±8.41S/CO,HBV DNA 4.27±1 .12 lg10 copy/L,ALT 1404.98±906.22 U/L,TBIL 95.24±69.03μmol/L,respectively.It took 22.87±10.16 days for liver function to return to normal,13.87± 10.14 days and 10.05 ±9.66 days for serum HBsAg and HBV DNA to turn negative,respectively.Conclusion The incidence of adult acute hepatitis B is on the rise.Sexual transmission is currently one of the important routes to the spread adult acute hepatitis B.Vaccination of hepatitis B in the adults and high-risk groups might contribute to the reduction of adult acute hepatitis B.%目的：观察成人急性乙型肝炎患者的临床流行病学的特征，为防治成人急性乙型肝炎提供建议。方法回顾性分析2009年1月至2012年12月109例急性乙型肝炎患者的流行病学资料，血清 HBV 标志物，肝功能及临床转归。结果急性乙型肝炎患者以男性为主，男女比例为5．06∶1；发病年龄主要为20～59岁，占93．57％。全部患者中有96．34％既往未曾接种过乙型肝炎疫苗或既往接种史不详。性接触传播为重要途径之一，共27例，占24．77％。临床治愈率高达94．50％。全部患者入院时抗-HBc IgM 为（20．38±8．41）S／CO，HBV DNA 为（4．27±1．12）lg 拷贝／mL，ALT 水平为（1404．98±906．22）IU／L，TBil 为（95．24±69．03）μmol／L；肝功能恢复正常时间为（22．87±10．16）d；血清 HBsAg 转阴时间为（13．87±10．14）d，HBV DNA 转阴时间为（10．05±9．66）d。结论成年人急性乙型肝炎的发病率呈上升趋势，性传播途径是目前成人急性乙型肝炎重要感染途径之一，建议成人和高危人群开展乙型肝炎疫苗的接种以降低成人急性乙型肝炎的感染率和发病率。