Study On Prevalence Of Chronic Hepatitis B Infection And Its Clincal Outcome Based-on Community Medical Examination In Zhangqiu District Of Jinan City,China

[Background]Viral Hepatitis B(HB)is a contagious disease mainly caused by liver cells infected by Hepatitis B Virus(HBV),which is a disease emphasis controlled by the world and our country.It is one of the most prominent public health problems in our country.As a major hepatitis B country,about 93 million people are infected with HBV,which about 20 million cases were chronic hepatitis B.It is estimated that there are 300,000 cases death from hepatitis B-related liver disease each year.Both the number of infected and death occupied 1/3 of the corresponding cases in the world,posing a heavy burden to our countries and families.Therefore,it is important to reduce the incidence and mortality of HB.At present,it was generally a sample survey about hepatitis B infection survey in our country.It is more realistic to reflect the prevalence of hepatitis B among the population based on surveys of hepatitis B infection among residents in the community as compared to the sample survey.Additionally,it is more important to learn the status of HBV infection in a region and to carry out relevant interventions measures.It is a direct index to evaluate hepatitis B control in a region using new HBV infection,especially new chronic infection.However,it is often used the incidence of acute hepatitis B as an alternative indicator in our country.The data come from the legal infectious disease reporting system,usually reported false data.Therefore,it is instructive to study the new infection of HBV and the influencing factors for the development of comprehensive prevention and treatment measures.In the past,most of the studies on the clinical features of patients with chronic hepatitis B infection were hospital-based studies on HB cases.There are few reports on the clinical composition and characteristics of HBsAg-positive patients at the community level.It is very important to scientifically formulate a management strategy for chronic hepatitis B infection to reduce the mortality of hepatitis B,with a comprehensive analyzing of community-level HBsAg-positive clinical features,characteristics,outcomes and five indicators of hepatitis B and their different combinations in the population prevalence.[Objectives]1.To provide the reference for predominating the proportion and distribution of hepatitis B susceptibility and source of infection through analyzing the prevalence of HBsAg and the prevalence of HBV serological parameters in HBsAg positive population in Zhangqiu district of Jinan city.2.To provide data support for determining the key population of hepatitis B prevention and control by comparing the two physical examination data to obtain the new population infection rate and distribution characteristics of hepatitis B population in Zhangqiu community.3.To provide a reference for the scientific development of hepatitis B virus chronic infection management policy by following up the HBsAg positiveand exploring the clinical outcome and related factors of different clinical status of HBsAg positivein Zhangqiu district of Jinan city.[Methods]1.Survey methodsWe determined Shengjing,Guanzhuang,Longshan,Dangjia,Diaozhen,Xiuhui and Zaoyuan as the research site,using stratified cluster sampling method from 21 towns in Zhangqiu District of Jinan City,based on geographical location,economic status and personnel mobility.The personal basic information and health examination information were collected through questionnaire survey.The serum samples were also collected to detect theHBsAg,anti-HBsandanti-HBc,to distinguish between HBsAg positive and non-infected population.All the people with HBsAg positive were given medical examination.They were classified and followed-up based on the results of interrogation,physical examination and abdominal B-ultrasound,then to understand thesituation of outcome.2.Analysis methods(1)Using Excel 2010 to analyze thedistributed situation of population,education,occupation,marriage,medical expenses payment composition,physical examination rate,rate of HBsAg positive,rate of new chronic infection,clinical features of HBsAg positive,HBsAg turned to negative,HBV carriers progress to chronic hepatitis B,HBeAg positive conversion to anti-HBe positive,HBeAg seroconversion after reversal.(2)Chi-square tests were performed for age,sex and the positive rate of HBsAg using SPSS 16.0 software.The differences inthe rates of new infection in different age groups,gender,educational level,occupation,marriage,medical expenses were analyzed by Poisson regression model.The following factors of HBsAg turned to negative,HBV carriers progressed to chronic hepatitis B,HBeAg positive conversion to anti-HBe positive,HBeAg seroconversion after reversalwere analyzed using Cox regression model.[Results]1.The prevalence of HBsAgThe total positive rate of HBsAg was 1.92%(95%CI:1.86%-1.98%)in zhangqiu district of Jinan city.Significantstatistical association was found in the positive rate between male population[OR=2.12%,95%CI:2.02%-2.22%]and female population[OR=1.76%,95%CI:1.68%-1.84%].The positive rate is highest in the group of 30-39 years and lowest in the group of 0-9 years.There is significant association between different groups.Significant association was found between different groups of town.2.New infection of HBsAgWe found 616 people newly infected during follow-up.The rate of new infection was 0.18/100 person-years.There was no significant relationship between the male populations and the female population.The rate of new infection was lower than 0.10per 100 person-years in the groups under 30 years.It is rising rapidly to 0.21per 100 person-years in the group of 30-39 years,0.23per 100 person-years in the group of 40?49 years and 0.26per 100 person-yearsin the group of 50?59 years.There were statistically significant differences in the rates of new infectionsbetween the comparisons.3.The clinical outcome and influences factors of HBsAg positive patientsThirteen types of HBV serological indicators were detected in the HBsAg positive population.Among the1267 hepatitis B carriers who completed two follow-up visits,HBsAg was conversion negative in 91 peoples,and the rate of conversion negative was 5.55 per 100 person-years.However,multivariate Cox regression analysis indicated that no significant difference was found in the likelihood of HBsAg conversion negative between all the included groups.Forty seven of the 1267 hepatitis B carriersdeveloped into chronic hepatitis B at the second physicalexamination,and the rate of development was 2.87 per 100 person-years.Multivariate Cox regression analysis indicated that the risk of developing to chronic hepatitis B could increase in the people with drinking history.Seventy five of 209 HBeAg positive and anti-HBe negative infections completed HBeAg seroconversion at the second physicalexamination,with the total seroconversion rate of 35.89 per 100 person-years.Multivariate Cox regression analysis indicated that no significant difference was found in the risk of HBeAg seroconversion rate between all the included groups.Ninety six of 931 HBeAgseroconversioninfections developed reversal at the second physicalexamination,with the total reversal rate of 8.14 per 100 person-years.Results from univariate Cox regressionand multivariate Cox regression analyses indicated the risk of reversal is higher in the group of HBV DNA>2000copesi/mL as compared with HBV DNA<2000 copies/mL.[Conclusion]1.The positive rate of HBsAg decreased by implementing comprehensive prevention and control measures,which was lower than the national level.Additionally,the positive rate of HBsAg in male population was higher than in female population.In the age group analysis,the group of 30?39 years had the highest positive rate of HBsAg.2.The new infection rate of HBV was 0.18 per 100 person-years during our follow up.The new infection rate was lower in the age group under 30 years and was highest in the age group of 50-79 years.3.Thirteen types of HBV serological indicators were detected in the HBsAg positive population.It could increase the risk of processing to chronic hepatitis B in those people with drinking history.The reversal risk after serological conversion of HBeAg increased in the people with HBV DNA>2000copies/mL[Suggestion]1.In view of the highest positive rate of HBsAg in the age group 30-39 years and the rapidly increased in new infection rates,suggesting that it may spread through other means of non-mother-to-child transmission.Therefore,strengthen the propaganda and education of hepatitis B knowledge,hepatitis B related prevention and control knowledge of publicity and education through a variety of ways,improved awareness of disease prevention and personal hygiene,reduced close contact in life should be recommended to prevent and control hepatitis B.2.It is recommended to strengthen health education in the follow-up of infected persons,to improve the awareness of the importance of follow-up,and to timely adopt targetedmedical interventions based on clinical outcome due to the higher rate of hepatitis B carriers development to chronic hepatitis Band higher rate of reversal afterserological conversion and lower rate of chronic hepatitis B antiviral therapy.Therefore,we should explore an effective medical insurance payment patterns and community management patterns for infected people to improve compliance of follow-up visits.