Hann Hie-Won L, Hann Richard S, Maddrey Willis C
Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Am J Gastroenterol. 2007 Apr;102(4):767-72. doi: 10.1111/j.1572-0241.2007.01060.x.
During the past decades, the influx of immigrants from hepatitis B virus (HBV) endemic regions has brought significant changes in the prevalence of HBV-associated liver diseases and hepatocellular carcinoma (HCC) in the United States. Our program, which was intended to identify those in need of hepatitis B vaccination, helped us to learn of the natural history of HBV infection in Korean Americans.
Between November of 1988 and May 1990, we screened 6,130 Korean Americans in the eastern United States for HBV infection.
The overall hepatitis B surface antigen (HBsAg) (+) rate was 6.1%, with 8.0% for males and 4.4% for females. The carrier rate peaked in subjects between the ages of 21 and 40 yr. The HBsAg (+) rate for 452 U.S.-born children was lower (2.7%) than that of 623 Korean-born (5.5%). None received hepatitis B immune-globulin or HBV vaccination. The vertical transmission rate was 30.3% in children born to HBsAg (+) mothers and 100% in those born to hepatitis B e antigen (HBeAg) positive mothers. In contrast, the paternal transmission rate was low; 10.3% in children with HBsAg (+) fathers and 19.2% in those with HBeAg (+) fathers. Another significant observation was the unexpected finding of ongoing liver diseases in incidentally identified carriers. Evaluation of 139 asymptomatic adult carriers revealed that 42% had elevated liver enzymes and 11% had already developed liver cirrhosis.
These findings strongly suggest the need for active HBV screening of immigrants from endemic regions and, most importantly, the need for careful monitoring of the carriers.
在过去几十年间，来自乙型肝炎病毒（HBV）流行地区的移民涌入，使得美国HBV相关肝病和肝细胞癌（HCC）的患病率发生了显著变化。我们旨在识别那些需要接种乙肝疫苗的人群的项目，帮助我们了解了韩裔美国人中HBV感染的自然史。
1988年11月至1990年5月期间，我们对美国东部的6130名韩裔美国人进行了HBV感染筛查。
乙肝表面抗原（HBsAg）总体阳性率为6.1%，男性为8.0%，女性为4.4%。携带率在21至40岁的人群中达到峰值。452名在美国出生的儿童的HBsAg阳性率（2.7%）低于623名在韩国出生的儿童（5.5%）。他们均未接受乙肝免疫球蛋白或HBV疫苗接种。HBsAg阳性母亲所生儿童的垂直传播率为30.3%，乙肝e抗原（HBeAg）阳性母亲所生儿童的垂直传播率为100%。相比之下，父系传播率较低；HBsAg阳性父亲的子女中为10.3%，HBeAg阳性父亲的子女中为19.2%。另一个重要发现是，在偶然发现的携带者中意外发现了正在发生的肝病。对139名无症状成年携带者的评估显示，42%的人肝酶升高，11%的人已经发展为肝硬化。
这些发现强烈表明，有必要对来自流行地区的移民进行积极的HBV筛查，最重要的是，有必要对携带者进行仔细监测。
