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杭州市2004–2011年戊型肝炎流行特征及病原学分析
作者:考庆君 孙昼 谢立 濮小英 杨旭辉 黄仁杰

摘要:

目的

分析杭州市2004–2011年戊型肝炎(简称戊肝)的流行特点以及戊肝病毒基因分型特点。

方法

利用中国疾病预防控制信息系统《疾病监测信息报告管理系统》,收集2004–2011年杭州市戊肝的发病情况及患者的基本信息。于2011年在杭州市定点传染病医院,采用随机数字表法选取实验室已确诊的戊肝患者65例,采集其血液标本60份及粪便标本18份;在全市范围内采用随机整群抽样的方法选取杭州市1个城区及2个周边县区,选取该区生猪定点屠宰场及农户作为采样点,采集猪胆囊标本52份,采集散养猪和兔子的粪便分别为30和15份。对标本进行戊肝病毒检测,并进行基因提取和基因序列分析,将测得的核酸序列与GenBank数据库中戊肝病毒毒株的基因序列进行比对,并绘制进化树。对2004–2011年杭州市戊肝发病流行特征进行描述,分析杭州市各年份及性别间戊肝发病率的差异。

结果

2004–2011年杭州市累计报告戊肝患者3 490例,死亡3例,年平均发病率为5.79/10万(3 490/60 276 338)。不同年份间发病率呈上升趋势(χ2=52.38,P<0.01),其中2011年最高,为8.10/10万(705/8 700 373),2005年最低,为4.19/10万(304/7 259 008);男性[8.12/10万(2 474/30 450 990)]高于女性[3.46/10万(1 016/29 384 491)] (χ2=558.45,P<0.05)。采集确诊患者血液及粪便标本共78份,检出阳性标本16份,阳性率为21%,采集猪胆、猪粪便、兔子粪便标本共97份,检出2份兔子粪便阳性标本,阳性率为2%。杭州市分离的戊肝病毒基因以Ⅳ型为主,同源性为91.8%~100%;与人戊肝病毒Ⅳ型毒株同源性为84.6%~96.7%;与猪分离的戊肝Ⅳ型病毒株同源性为82.6%~95.2%。

结论

杭州市戊肝发病年呈逐年上升趋势,戊肝病毒基因型以Ⅳ型病毒株为主,在人群中与猪群中存在高度同源性。

关键词:肝炎,戊型;肝炎病毒,戊型;基因型;流行特征;疾病控制

Abstract:

Objective

To comprehend the epidemiologic of hepatitis E and genetic characteristics of hepatitis E virus (HEV) in Hangzhou from 2004 to 2011.

Methods

Using China information system for disease control and prevention, the incidence of hepatitis E from 2004 to 2011 in Hangzhou city, and the basic information of patients were collected. In 2011, 65 hepatitis E laboratory confirmed cases were selected by random number table sampling method from the hospitals designated infectious diseases in Hangzhou city, and acquisition of the 60 blood specimens and stool specimens of 18 copies. One city and two surrounding counties were selected by cluster random sampling method in the context of Hangzhou city, and the pig slaughters and farmers were selected as the sampling point, and acquisition of pig gallbladder specimens of 52 copies, and 30 stool samples of scatter-feed pigs, 15 stool specimens of scatter-feed rabbits. HEV was tested in samples, gene extraction and analysis of gene sequence were conducted which were compared with gene bank HEV gene sequence, and a phylogenetic tree was formed. The epidemic characteristics of hepatitis E of Hangzhou city from 2004 to 2011 were described. The difference of incidence of hepatitis E was analyzed between years and sexes in Hangzhou city.

Results

There were reported a total of 3 490 cases of hepatitis E in Hangzhou from 2004 to 2011, and 3 cases of death; The average annual incidence rate was 5.79/100 000 (3 490/60 276 338). There was the overall upward trend in incidence between different years (χ2=52.38, P<0.01), which the highest was 8.10/100 000 (705/8 700 373) in 2011, and the lowest incidence rate was 4.19/100 000 in 2005. The incidence of males (8.12/100 000 (2 474/30 450 990)) was significantly higher than that of the females (3.46/100 000 (1 016/29 384 491)) (χ2=558.45, P<0.05). 78 specimens of blood and stool were collected, including 16 positive samples, with positive rate 21%. There were a total of 97 specimens of pig gallbladder, pig manure and rabbit stool, including 2 positive rabbit stool samples, with positive rate of 2%. HEV genes isolated from Hangzhou were mainly type Ⅳ, with homology of 91.8% to 100%; compared with human type Ⅳ strains, the homology of nucleotide was 84.6%-96.7%; compared with type Ⅳ strain of pig genome sequence alignment, homology was 82.6%-95.2%.

Conclusion

Hepatitis E′s incidence showed an increasing trend year by year in Hangzhou. HEV of type Ⅳ was dominant, and HEV strains in the human and swine were highly homologous.

Key words: Hepatitis E;Hepatitis E virus;Genotype;Epidemiologic characteristics;Disease control

发表日期:2014/9

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2014.09.005.T001:表1 PCR测序所用引物序列

    10.3760/cma.j.issn.0253-9624.2014.09.005.T001:表1 PCR测序所用引物序列

  • 10.3760/cma.j.issn.0253-9624.2014.09.005.T002:表2 参考的全序列戊型肝炎病毒株

    10.3760/cma.j.issn.0253-9624.2014.09.005.T002:表2 参考的全序列戊型肝炎病毒株

  • 10.3760/cma.j.issn.0253-9624.2014.09.005.T003:表3 2004–2011年杭州市不同性别居民戊型肝炎的发病情况

    10.3760/cma.j.issn.0253-9624.2014.09.005.T003:表3 2004–2011年杭州市不同性别居民戊型肝炎的发病情况

  • 10.3760/cma.j.issn.0253-9624.2014.09.005.F001:图1 杭州市戊型肝炎病毒毒株核苷酸序列系统进化树

    10.3760/cma.j.issn.0253-9624.2014.09.005.F001:图1 杭州市戊型肝炎病毒毒株核苷酸序列系统进化树

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