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目的调查天津铁路疾病预防控制(疾控)所辖区内从业人员戊型肝炎病毒(HEV)感染情况,探讨戊型肝炎感染与人群年龄、性别、地区及职业分工、水源环境之间的关系。方法选取2012—2013年在北京铁路局天津铁路疾控中心进行预防性健康检查的从业人员共计9 897人,按照年龄、性别、地区、职业分工、水源环境不同分组,检测血清中抗HEV-Ig M和抗HEV-Ig G,以及丙氨酸氨基转移酶(ALT)和总胆红素(TBil),并对血清中抗HEV-Ig M阳性者血清和粪便标本进行HEV RNA的提取。结果辖区内从业人群抗HEV-Ig M阳性率为0.283%,性别、年龄组地区间差异均无统计学意义(均P>0.05)。抗HEV-Ig G的阳性率为36.05%,男性HEV感染率明显高于女性(P<0.05),随着年龄增加阳性率也增长(P<0.05)。而抗HEV-Ig G阳性率在地区间差异有统计学意义。ALT和TBil 2项生化指标,抗HEV-Ig M阳性组比阴性组显著降低(P<0.05),而抗HEV—Ig G阳性组与阴性组无显著差异(P<0.05)。从事食品工作组抗HEV-Ig M阳性率最高,而供水组抗HEV-Ig G阳性率最高,各组有显著差异(P<0.05)。集中式供水组和分散式供水组之间抗HEV-Ig M阳性率无明显差异,但抗HEV-Ig G阳性率差异有统计学意义。28例抗HEV-Ig M阳性血清标本中有1份血清标本HEV RNA阳性,有4例粪便标本HEV RNA阳性。结论该辖区内HEV的新近感染率在性别、年龄间无显著差异,但既往感染率男性高于女性,并随年龄增长而增高。辖区内从业人群感染HEV均为隐性感染。HEV新近感染可能主要通过食物传播,而既往感染可能以水源传播为主。HEV的主要传播方式为粪—口途径,但血液传播的可能并不能排除。
Objective To investigate the status of hepatitis E virus (HEV) infection among practitioners in Tianjin Railway Disease Prevention and Control (CDC) area and to explore the relationship between hepatitis E infection and age, sex, region, occupational division of labor and water environment. Methods A total of 9 897 employees were selected for preventive health examination at Tianjin Railway CDC of Beijing Railway Bureau from 2012 to 2013. The levels of anti-HEV-Ig in serum were determined according to age, gender, region, occupational division, and water environment. M and anti-HEV-Ig G, and alanine aminotransferase (ALT) and total bilirubin (TBil), and HEV RNA was extracted from serum and stool specimens of anti-HEV-Ig M positive sera. Results The positive rate of anti-HEV-Ig M among the employed population in the area was 0.283%. There was no significant difference between the sexes and the age groups (all P> 0.05). The positive rate of HEV-Ig G was 36.05%. The infection rate of HEV in male was significantly higher than that in female (P <0.05). The positive rate of HEV-Ig G also increased with age (P <0.05). The positive rate of anti-HEV-Ig G in the region was statistically significant. The biochemical indexes of ALT and TBil were significantly lower in HEV-Ig M positive group than those in negative group (P <0.05), but not in HEV-Ig G positive group and negative group (P <0.05). The positive rate of anti-HEV-Ig M was highest in the food working group, while the positive rate of HEV-Ig G in the water supply group was the highest, with significant difference (P <0.05). There was no significant difference in the positive rate of anti-HEV-Ig M between the centralized water supply group and the distributed water supply group, but the positive rate of anti-HEV-Ig G was statistically significant. One of the 28 anti-HEV-Ig M positive serum samples was positive for HEV RNA, and 4 stool specimens were positive for HEV RNA. Conclusion The recent infection rate of HEV in this area has no significant difference in gender and age, but the prevalence of previous infection is higher in males than in females and increases with age. Infected area practitioners are infected with HEV are latent infection. Recent infections with HEV may predominate through food, whereas past infections may predominate with water. The main mode of transmission of HEV is the fecal-oral route, but the possibility of blood transmission can not be ruled out.