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【摘要】 目的 了解某农村人群甲、乙、丙、戊和庚型肝炎病毒的感染状况及其流行特点。方法 应用酶联免疫试验(EIA)检测血清抗-HAV、HBsAg、抗-HBs、抗-HBc、抗-HCV、抗-HEV和抗-HGV，并对抗-HGV阳性者应用套式逆转录聚合酶链反应法(RT-nPCR)检测HGV RNA。结果 该人群抗-HAV、抗-HCV、抗-HEV和抗-HGV流行率分别为86.9%、11.5%、2.9%和1.8%，HBsAg阳性率为8.0%，HBV总感染率为54.8%。HAV以5岁以下儿童感染率最低(35.0%)，到10岁时85.0%的儿童已感染HAV。HBsAg阳性率呈现两个高峰，分别在5～9岁和40～49岁年龄组；HBV总感染率到10岁时为55.0%，然后随年龄增长而上升。HCV感染主要集中在20～49岁年龄组(占77.8%)。各型肝炎病毒男女感染率无明显差异。献浆次数、年限与HCV、HEV、HGV感染呈正相关。HBsAg、抗-HBc、抗-HCV呈现家庭聚集性，但仅HBsAg呈现母亲与子女相关。抗-HCV阳性者中ALT异常率(15.9%)显著高于抗-HCV阴性者(1.2%，P＜0.01)。结论 该人群甲、乙、丙、戊和庚型肝炎病毒感染具有不同的流行病学特点；献血浆是该人群HCV、HEV和HGV感染的主要危险因素；抗-HCV阳性者多伴有肝损害。
A cross-sectional study on HAV,HBV,HCV,HEV and HGV infection in a rural population
CUI Yihui,ZHUANG Hui,SUN Degui,et al.
Department of Microbiology,Beijing Medical University,Beijing 100083
【Abstract】 Objective To study the epidemiological characteristics of HAV,HBV,HCV,HEV and HGV infections in a rural population. Methods Enzyme immunoassays were used for detection of anti-HAV,HBsAg,anti-HBs,anti-HCV,anti-HEV and anti-HGV. Anti-HGV positive sera were further tested for HGV RNA using a reverse transcription nested PCR. Results The prevalence rates of anti-HAV,HBsAg,anti-HCV,anti-HEV,anti-HGV in the studied population were 86.9%,8.0%,11.5%,2.9% and 1.8%,respectively. The total infection rate of HBV was 54.8%. The HAV infection rate of children below 5 was the lowest (35.0%) as compared with other age groups. 85.0% of children at 10 years old had already been infected with HAV. The HBsAg positive rate showed two peaks at 5-9 and 40-49 age groups. The total infection rate of HBV was 55.0% in the age group less than 10 years old and increased with age. HCV infection mainly occurred in the age group of 20-49 (77.8%). The prevalence rates of anti-HCV,anti-HEV and anti-HGV increased with the frequencies and duration of plasma donation. Family clusterings of HBsAg,anti-HBc and anti-HCV were observed. However,only with HBsAg showed a correlation between mothers and their offspring.The frequency of abnormal ALT in anti-HCV positive individuals was significantly higher as compared with that in those with negative anti-HCV. No difference was observed in the frequencies of elevated ALT between those with or without HAV,HBV,HEV and HGV markers. Conclusion HAV,HBV,HCV,HEV and HGV infections had different epidemiological characteristics. Plasma donation was the major risk factor for HCV,HEV and HGV infections in this population under study. Anti-HCV positive individuals are more likely to have active HCV infection.
【Key words】 Viral hepatitis Mode of transmission Risk factors Plasma donation Family clustering
本研究选择河北省某农村自然人群为研究对象，通过对比分析，探讨了甲、乙、丙、戊和庚型肝炎在该人群中的流行病学特点，以便为当地卫生防疫部门制订病毒性肝炎的防治策略提供依据。
材料与方法
一、研究对象：河北省某农村人群登记在册人口共计549名。
二、调查方法：采用问卷调查方式，由专人逐户逐人按统一调查表进行询问调查。不能自己回答的对象(如婴幼儿、学龄前儿童、高龄老人)由知情者(父母、子女)代答。对每名研究对象采集其外周静脉血3～5ml，24小时内分离血清并检测血清谷丙转氨酶(ALT)，剩余血清置-20℃冰箱保存备检。
三、血清谷丙转氨酶(ALT)的检测：采用改良赖氏法，≥25IU为异常。
四、血清抗-HAV、HBsAg、抗-HBs、抗-HBc、抗-HCV、抗-HEV、抗-HGV检测：均采用酶联免疫试验法(EIA)。
五、HGV RNA的检测：应用本室建立的HGV RNA逆转录套式聚合酶链反应法(RT-nPCR)［1］。
六、诊断标准：由于该村无一人注射过甲型或乙型肝炎疫苗，因此，抗-HAV阳性者为既往曾感染HAV；HBsAg、抗-HBs和抗-HBc 3项标志中有一项阳性者为HBV感染。抗-HCV、抗-HEV和抗-HGV阳性者为HCV、HEV、HGV感染。
七、资料分析和处理：数据输入微机，应用EPI-INFO和SAS软件进行统计分析。
结 果
一、HAV、HBV、HCV、HEV和HGV感染率及其性别和年龄分布：该人群抗-HAV阳性率为86.9%(477/549)，标化阳性率为88.1%。HBsAg、抗-HBs和抗-HBc阳性率分别为8.0%(44/549)、27.0%(148/549)和38.6%(212/549)，HBV总感染率为54.8%(301/549)，标化感染率为55.1%。抗-HCV阳性率为11.5%(63/549)，标化阳性率为11.4%。抗-HEV阳性率为2.9%(16/549)，标化阳性率为3.1%。抗-HGV阳性率为1.8%(10/549)，标化阳性率为2.1%。在抗-HGV阳性者中，HGV RNA阳性者占60%(6/10)。经统计学检验，5型肝炎病毒感染率在男女间差异无显著性。
HAV感染率在5岁以下年龄组最低(35.0%)，以后随年龄增长而迅速上升，到10岁组达最高峰(96.1%)，以后各组几乎维持在同一水平(93.4%～95.8%)，60岁以上组略有下降(88.0%)。HBsAg阳性率在0岁组已达高水平(8.3%)，10岁组达最高峰