Follow-up Study Of Clinical Progress And Influencing Factors Of Chronic Hepatitis B Virus Infection Based On Population Screening In Rural Community

BackgroundViral Hepatitis B(HBV)is one of the important public health problems in the world.China is a major country with about 93 million chronic HBV infections,including about 20 million chronic hepatitis B patients.Due to the differences in human immune system and virus level,chronic hepatitis B patients have various clinical outcomes,including HBV carrier,chronic hepatitis B,hepatitis B cirrhosis,hepatocellular carcinoma(HCC)and other disease course evolution.According to statistics,more than 650,000 people worldwide die from HBV-related disease every year.In addition,some studies have pointed out that inactive HBsAg carriers still have the risk of HBV reactivation,which can cause acute hepatitis and even acute liver failure or death.The current studies on chronic HBV infection are mainly based on hepatitis B patients in hospitals,and most of them are retrospective studies.At the community level,it is of great significance to dynamically analyze the changes of infection status of chronic HBV patients and explore the influencing factors based on the large cohort population,so as to formulate scientific hepatitis B prevention and treatment strategies and put forward targeted intervention measures.Objectives1.To analysis the characteristics and rules of the infection status of chronic HBV infection based on community populations and explore influencing factors.2.To understand the pathogenesis density and epidemiological characteristics of HBsAg carriers in community chronic HBV infected people,and to explore risk factors affecting HBV reactivation.Methods1.Survey objects:During the "Eleventh Five-Year Plan",my country has set up a few very important infectious disease prevention and control science and technology,Zhangqiu district,one of Jinan city,as a comprehensive control demonstration zone,which has undertaken community residents and infected people’s follow-up work.On this basis,the population was surveyed in 2018.This group was followed up again in 2020.2.Investigation method:The questionnaire survey is performed on all investigations.The investigation includes population characteristics,lifestyle,hepatitis B family history,anti-viral therapeutic history,chronic medical history,etc;collect blood specimens to detect HBsAg、anti-HBs、HBeAg、anti-HBe and anti-HBc,HBV DNA and liver function(ALT,AST,etc.).3.Analytical method:Data double entry using the Epi data3.1 database,using SPSS,Statal 1.2 software for data statistical analysis.A multi-set sample mean comparison variance analysis;the ratio is compared using χ2 test,and the correlation analysis uses pearson correlation analysis,single factor and multi-factor analysis adopt Cox proportional risk regression model.It was statistically significant with P<0.05.Results1.Baseline characteristics of chronic HBV infections:Among the 682 HBV infected patients,HBV carriers,chronic hepatitis B and cirrhosis accounted for 82.99%,16.13%and 0.88%,respectively.There were 12 serocombination patterns,among which HBsAg,anti-HBe and anti-HBc were positive and HBsAg,HBeAg and anti-HBc were positive,accounting for 78.45%and 12.46%,respectively.2.Clinical outcomes of hepatitis B carriers:566 cases of hepatitis B carrier follow-up to 2020,43 cases occurred seroclearance,the rate of HBsAg seroclearance was 3.74 per 100 person-years.Cox multi-factor analysis shows that compared with HBsAg content less than 100 KIU/L,100～250KIU/L(HR=0.23,95%CI:0.07～0.76,P=0.016)and>250KIU/L(HR=0.13,95%CI:0.00～0.10,P<0.001)decreased the possibility of HBsAg seroconversion.A total of 47 cases have progressed as chronic hepatitis B,the incidence density is 4.09 per 100 person-years.Cox multi-factor analysis shows,compared with male,women(HR=0.47,95%CI:0.26～0.86,P=0.015)had a lower risk of developing chronic hepatitis B.;relative to HBeAg negative,HBeAg-positive HBV carriers(HR=2.58,95%CI:1.32～5.03,P=0.006)had an increased risk of developing chronic hepatitis B;compared with normal ALT,HBV carriers with abnormal ALT(HR=3.99,95%CI:1.61～9.89,P=0.003)had an increased risk of progressing to chronic hepatitis B.Compared with HBsAg<100KIU/L,HBsAg>250KIU/L(HR=4.67,95%CI:1.04～20.89,P=0.044)had an increased risk of developing chronic hepatitis B.A total of 5 cases(0.88%)have progressed as cirrhosis,and the incidence density is 0.44 per 100 person-years.Compared with HBV carriers with normal AST,those with AST abnormalities(HR=7.93,95%CI:1.30～48.41,P=0.025)have an increased risk of progressing to cirrhosis.3.Patients with chronic hepatitis B:110 cases of chronic hepatitis B,4 cases(1.82%)are evolved for cirrhosis,the incidence density is 0.90 per 100 person-years.There was no significant difference in liver cirrhosis in patients with chronic hepatitis B patients with different characteristics(P>0.05).4.The HBV reactivation of inactive HBsAg carriers:419 inactive HBsAg carriers,HBV reactivation occurred in 47 cases,the cumulative reactivation rate was 11.22%,the incidence density was 5.52 per 100 person-years;baseline HBV DNA load is related to reactivation(P<0.05).After reactivation,the average level of AlT increased by the baseline and an abnormal rate,and the activator liver function tends to be abnormal.Hepatitis occurred in 4 patients(8.51%),and 1 patient(2.13%)was jaundice hepatitis.Conclusions1.People with chronic HBV infection in rural communities are mainly in the state of hepatitis B carriers.2.Hepatitis B carriers with low HBsAg content are more likely to develop HBsAg negative,and male,HBeAg positive,high level of HBsAg and abnormal ALT were more likely to develop chronic hepatitis B.Patients with chronic hepatitis B have a higher incidence of progression to cirrhosis.3.The HBV reactivation rate of inactive HBsAg carriers is relatively high,related to HBV viral load.SuggestionsIn order to prevent the incidence of adverse clinical outcome as early as possible,we should take targeted management for chronic HBV infection with different characteristics,strengthen the frequency of regular follow-up,strengthen the health monitoring of the population,pay close attention to the changes of liver function and virology level.