【摘要】 目的 分析云南省HBV感染的家庭聚集性、传播危险因素及结局情况，为控制HBV家庭聚集性传播提供策略。方法 选取2015年1月—2017年12月在昆明市第三人民医院确诊的HBsAg阳性患者，调查其家庭的人口学特征、实验室指标等。对HBsAg阳性者的家庭进行二项分布拟合优度χ~2检验并计算家庭聚集率。以单因素和多因素Logistic回归模型分析HBV传播及新发肝硬化或肝癌的影响因素。使用Kaplan-Meier法分析HBsAg阳性者肝硬化或肝癌的累积发生率，并采用Log-rank检验进行比较。结果 共调查459户HBsAg阳性家庭，包括618例HBsAg阳性者和918例HBsAg阴性者，其中有107户≥2名家庭成员HBsAg阳性，家庭聚集率为23.31%（χ~2=95.393,P<0.001）。传播方式以母婴传播为主。多因素Logistic回归分析结果显示，性别（OR=0.397,95%CI:0.270～0.584,P<0.001）、民族（OR=1.655,95%CI:1.035～2.648,P=0.036）、月收入（OR=1.612,95%CI:1.094～2.375,P=0.016）、共用洁具（OR=2.789,95%CI:1.530～5.086,P<0.001）、基线肝硬化（OR=2.702,95%CI:1.404～5.203,P=0.003）、总胆固醇（OR=0.772,95%CI:0.657～0.908,P=0.002）和HBV DNA(OR=2.063,95%CI:1.753～2.428,P<0.001)是HBV家庭聚集性传播的独立影响因素。618例HBsAg阳性者平均随访4.80年，累积新发肝硬化或肝癌85例（13.75%）;KaplanMeier法分析结果显示，HBV传播聚集性家庭的肝硬化或肝癌的累积发生率高于非聚集性家庭（χ~2=10.629,P<0.001）。以是否抗病毒治疗、是否为HBV聚集性传播家庭对618例HBsAg阳性患者进行分层分析，结果显示HBV传播聚集性家庭且未抗病毒治疗者的肝硬化或肝癌的累积发生率最高（32.50%），非HBV传播聚集性家庭且抗病毒治疗者的肝硬化或肝癌的累积发生率最低（3.33%）。结论 HBsAg阳性者具有家庭聚集性，应加强其家庭成员的筛查、健康宣传教育和追踪观察。抗病毒治疗能有效降低聚集家庭内肝硬化和肝癌的发生率。更多还原

【Abstract】 Objective To investigate the condition of hepatitis B virus(HBV) infection in Yunnan, China, in terms of familial aggregation, risk factors for transmission, and outcome, and to provide strategies for controlling the familial aggregation transmission of HBV. Methods The HBsAg-positive patients who were diagnosed in The Third People’s Hospital of Kunming from January 2015 to December 2017 were enrolled, and related data were analyzed, including demographic features and laboratory markers. The chi-square goodness-of-fit test for binomial distribution was performed for the families of the HBsAg-positive patients, and the familial aggregation rate was calculated. The univariate and multivariate Logistic regression models were used to analyze the risk factors for HBV transmission and new-onset liver cirrhosis or liver cancer. The Kaplan-Meier method was used to investigate the cumulative incidence rate of new-onset liver cirrhosis or liver cancer in HBsAg-positive patients, and the log-rank test was used for comparison. Results A total of 459 HBsAg-positive families were analyzed, involving 618 HBsAg-positive individuals and 918 HBsAg-negative individuals, and among these families, 107 had ≥2 HBsAg-positive family members, with a familial aggregation rate of 23.31% （χ~2=95.393, P<0.001）. The mode of transmission was mainly mother-to-child transmission. The multivariate Logistic regression analysis showed that sex(odds ratio [OR]=0.397, 95% confidence interval [CI]: 0.270-0.584, P<0.001), nationality(OR=1.655, 95%CI: 1.035-2.648, P=0.036), monthly income(OR=1.612, 95%CI: 1.094-2.375, P=0.016), shared sanitary appliance(OR=2.789, 95%CI: 1.530-5.086, P<0.001), liver cirrhosis at baseline(OR=2.702, 95%CI: 1.404-5.203, P=0.003), total cholesterol(OR=0.772, 95%CI: 0.657-0.908, P=0.002), and HBV DNA(OR=2.063, 95%CI: 1.753-2.428, P<0.001) were independent influencing factors for the familial aggregation transmission of HBV. The 618 HBsAg-positive patients were followed up for a mean time of 4.80 years, with 85 cases(13.75%) of new-onset liver cirrhosis or liver cancer, and the Kaplan-Meier analysis showed that the families with familial aggregation transmission of HBV had a significantly higher cumulative incidence rate of liver cirrhosis or liver cancer than those without familial aggregation transmission （χ~2=10.629, P<0.001）. A stratified analysis was performed for the 618 HBsAgpositive patients based on the presence or absence of antiviral therapy and familial aggregation transmission of HBV, and the results showed that the patients who came from the family with familial aggregation transmission of HBV and did not receive antiviral therapy had the highest cumulative incidence rate of liver cirrhosis or liver cancer(32.50%), while those who came from the family without familial aggregation transmission of HBV and received antiviral therapy had the lowest incidence rate of liver cirrhosis or liver cancer(3.33%). Conclusion Familial aggregation is observed in HBsAg-positive individuals, and screening, health education, and follow-up observation should be strengthened for their family members. Antiviral therapy can effectively reduce the incidence rates of liver cirrhosis and liver cancer in families with aggregation transmission.更多还原