Gane E
Department of Gastroenterology, Middlemore Hospital, Auckland.
N Z Med J. 1998 Apr 10;111(1063):120-3.
Previous studies have identified high prevalence rates of hepatitis B infection in New Zealand Maori, Pacific Island and Asian populations within New Zealand. However, the true impact of chronic hepatitis B virus (HBV) infection on health resources has not been evaluated. This study was designed to determine the incidence of serious sequelae of chronic HBV infection in a high prevalence community.
All patients treated for HBV-related conditions at Middlemore Hospital from January 1995 to January 1997 were identified through discharge coding and laboratory records. Demographic characteristics and laboratory results, including liver function tests, hepatitis serology and liver histology were recorded. Number of admissions, average length of stay and survival were calculated from Casemix data.
During the study period, 215 patients were referred for management of hepatitis B infection, of whom 179 had persistently elevated aminotransferases. Forty six percent of patients were hepatitis B 'e' antigen (HBeAg) negative, and 21% of these had delta co-infection (all Samoan). Liver biopsy was performed in 87 patients with raised aminotransferases. No features of chronic hepatitis were found in 5%, mild chronic hepatitis in 30%, moderate to severe chronic hepatitis in 44% and cirrhosis in 22%. Fifty five patients were admitted to hospital during the two year period with an HBV-related diagnosis, with an average length of stay of 12.2 days compared to 4.9 days for all other medical and surgical admissions during this period (p < 0.001). Twenty eight of the 55 subsequently died, 20 from hepatocellular carcinoma.
Chronic hepatitis B infection is associated with significant morbidity and mortality in Maori, Pacific Islanders and Asians living in South Auckland. Screening of these high risk populations with vaccination of noninfected individuals should reduce the incidence of these serious sequelae and eventually lead to eradication of HBV.
以往研究已确定新西兰毛利人、太平洋岛民及新西兰境内亚洲人群中乙型肝炎感染率很高。然而，慢性乙型肝炎病毒（HBV）感染对卫生资源的实际影响尚未得到评估。本研究旨在确定高流行社区中慢性HBV感染严重后遗症的发生率。
通过出院编码和实验室记录确定1995年1月至1997年1月在Middlemore医院接受HBV相关疾病治疗的所有患者。记录人口统计学特征和实验室结果，包括肝功能检查、肝炎血清学和肝脏组织学。根据病例组合数据计算入院次数、平均住院时间和生存率。
在研究期间，215例患者因乙型肝炎感染接受治疗，其中179例转氨酶持续升高。46%的患者乙型肝炎e抗原（HBeAg）阴性，其中21%合并丁型肝炎感染（均为萨摩亚人）。87例转氨酶升高的患者进行了肝活检。5%未发现慢性肝炎特征，30%为轻度慢性肝炎，44%为中度至重度慢性肝炎，22%为肝硬化。在这两年期间，55例患者因HBV相关诊断入院，平均住院时间为12.2天，而同期所有其他内科和外科入院患者的平均住院时间为4.9天（p<0.001）。55例患者中有28例随后死亡，20例死于肝细胞癌。
慢性乙型肝炎感染与居住在南奥克兰的毛利人、太平洋岛民和亚洲人的高发病率和死亡率相关。对这些高危人群进行筛查并对未感染个体进行疫苗接种应可降低这些严重后遗症的发生率，并最终实现HBV的根除。
