“消除”背景下的丙型肝炎病毒感染现状及筛查、诊断对策

doi:10.16150/j.1671-2870.2024.01.001

摘要/Abstract

摘要：

2015年，丙型肝炎病毒（hepatitis C virus ，HCV）感染的全球流行率为0.9%，但随着病毒性肝炎清除工作的全面铺开，至2020年，HCV在全球的流行率已降至0.7%,但全球仍有约5 800万HCV感染者和1 500万新发感染者，每年的HCV相关死亡病例达30万。2019年，我国HCV新发感染病例数达62.5万，经年龄校正后的发病率为[55 (47.5~63.2)]/10⁶。2006年，我国血清样本检测的流行病学调查显示，我国HCV感染的流行率约为0.43%。2016年的数据提示，我国的HCV相关死亡为45 300例，为全球高死亡率的地区。2022年，世界卫生组织（World Health Organization，WHO）提出了新的HCV消除结局指标，为HCV新发感染病例数<350 000例/年并在总人群中发病率<2/100 000 /年，静脉药瘾者(people who inject drugs, PWID)<2/100人年。我国HCV基因型分布亦呈现一定的特殊性，基因型以1b型为主,约占62.7%，其次为2a型（17.4%），西南地区3型（5%）呈现较高流行率。近年来，基因3b型占比除在我国北部地区有所下降，在其他地区均呈上升趋势。我国基因型及亚型的分布和演变增加了我国丙型肝炎（丙肝）消除的难度。WHO建议筛查高风险人群（PWID和囚犯等），并根据医疗记录调整高风险人群的筛查模式；政府应组织高流行区（抗HCV血清流行率≥2%或≥5%）的大规模筛查。HCV感染风险持续人群的再感染率约为4.13/100人年，PWID为2.84/100人年，男男性行为者为7.37/100人年，囚犯人群则为7.23/100人年。因此，WHO建议应对HCV感染风险持续人群在HCV治愈后进行重复HCV检测。2022年，WHO HCV指南和2022年WHO HCV简化医疗服务和诊断流程文件均建议简化HCV诊断路径。我国的HCV疾病负担沉重，目前我国的HCV感染和诊治现状距离2030年实现“消除病毒性肝炎的公共卫生危害的目标”尚有一定差距。

关键词: 丙型病毒性肝炎, 流行病学, 筛查, 诊断, 消除

Abstract:

Global prevalence of HCV infection was 0.9% in 2015. With the comprehensive rollout of viral hepatitis elimination efforts, the global prevalence of HCV infection has been reduced to 0.7% by 2020. However, there are still approximately 58 million people living with HCV globally and 15 million newly-diagnosed infections annually ，with 300 000 deaths per year. In 2019, the number of reported newly-diagnosed HCV cases in China reached 625 000, with an age-adjusted incidence rate of 55(47.5－63.2) per million. An epidemiological survey of serum samples in China in 2006 showed that the prevalence of HCV infection in the country was about 0.43%. Data in 2016 indicated that there were 45 300 HCV-related deaths in China, which was the region with highest mortality risk globally. In 2022, WHO proposed new outcome indicators for HCV elimination， including the number of newly-diagnosed HCV patients <350 000 cases per year, incidence of HCV <2/100 000 per year in total population,and incidence for people who inject drugs(PWID) <2/100 person-years. The distribution of HCV genotypes in China also presents certain particularities. Genotype 1b is predominant, accounting for about 62.7%, followed by genotype 2a (17.4%).There is a high prevalence of genotype 3 (5%) in the southwestern region. In recent years, the proportion of genotype 3b has shown a downward trend in the northern regions of China, but an upward trend in other areas. The distribution and evolution of genotypes and subtypes in China have increased the difficulty of eliminating hepatitis C in the country. The WHO recommends screening in high-risk populiation (PWID and prisoners, etc.) and adjusting screening patterns for high-risk groups based on medical records, as well as the government organizing large-scale screen in areas with high prevalence (anti-HCV sero-prevalence ≥ 2% or ≥ 5%). The reinfection rate among people with ongoing risk of HCV infection ，PWID,MSM and prisoners is about 4.13/100 person-years, 2.84/100 person-years, 7.37/person-years, and 7.23/100 person-years ，respectively. Therefore, the WHO suggests repeating HCV testing in people with ongoing risk of HCV infection after HCV cure. Both the 2022 WHO HCV guidelines and the 2022 WHO document on simplified medical services and diagnostic processes for HCV recommend simplifying the HCV diagnostic pathway. The burden of HCV disease in China is heavy, and there still is a certain gap between the current status of HCV infection and treatment and the goal of achieving the goal of eliminating viral hepatitis by 2030.

Key words: Hepatitis C, Epidemiology, Screening, Diagnosis, Elimination

中图分类号:

R512.63

黄睿, 饶慧瑛. “消除”背景下的丙型肝炎病毒感染现状及筛查、诊断对策[J]. 诊断学理论与实践, 2024, 23(01): 1-8.

HUANG Rui, RAO Huiying. Current status， screening and diagnostic strategies for hepatitis C virus infection in the context of “elimination”[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(01): 1-8.

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