慢性B型肝炎、C型肝炎盛行率及ALT異常率之村里別分佈及地理差異：台南縣520個村里之成人健檢分析

Village Distribution and Geographic Variations of the Prevalence of Chronic Hepatitis B, C and Hypertransaminemia: An Analysis of Adult Health Examinations in 520 Villages of Tainan County, Taiwan

陳寶妃(Pao-Fei Chen) ； 紀廣明(Kwong-Ming Kee) ； 陳耀德(Yao-Der Chen) ； 蔡玲珊(Lin-San Tsai) ； 施伶宜(Lin-Yi Shih) ； 林麗珠(Li-Chu Lin) ； 陳秀熙(Hsiu-Hsi Chen) ； 盧勝男(Sheng-Nan Lu)

《內科學誌》 17卷6期 (2006/12) Pp. 276-290

https://doi.org/10.6314/JIMT.2006.17(6).03

摘要

Background and Aims: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the two major causes of liver disease deaths in Taiwan. The impact of HCV infection has increased since the effective prevention of HBV infection. Epidemiologic studies of HCV, in comparison with HBV, have hither to been incomplete in Taiwan. Previous studies for the prevalence of HCV were limited to small-scale community studies, and no large-scale community studies for the screening of HBV and HCV have been published before. The purpose of this study is to investigate the prevalence of HB surface antigen (HBsAg), anti-HCV antibody (anti-HCV) and hypertransaminemia levels in villages in Tainan county, and to analyze geographic variations among villages throughout the whole county. Patients and Methods: Health examinations were carried out by the Health Bureau of Tainan County in 533 villages in Tainan county between April and November 2004. Residents aged ＞40 years (n=56702; men/women: 17551/39151) were invited for a series of examinations, including HBsAg, anti-HCV and alanine transaminase (ALT). The upper normal limit of ALT levels is 40 IU/L. Standardized morbidity ratio (SMR) was used to analyse prevalences of HBsAg, anti-HCV and hypertransaminemia in village levels of Tainan county. The method is prevalences of HBsAg, anti-HCV and hypertransaminemia in village levels were divided by overall prevalences of these three parameters respectively. Goodness-of-fit test for chi-square was used to test the significance difference between the prevalences. A total of 13 villages were excluded because the number of subjects enrolled was not sufficient for the chi-square test. Results: The overall prevalence of HBsAg, anti-HCV and hypertransaminemia was 10.9%, 10.2% and 12.8% respectively. In village-specific prevalences of HBsAg, the highest prevalence was in Jianan village (Guantian Township) (28.0%, 7/25), and the lowest prevalences were found in Kanping village (Cigu Township), Chungjung village (Anding Township), Chinsha village (Sigang Township) and Shichao village (Longci Township) , (all at 0%). There were nine villages with significant levels of SMR (≧2), and 21 villages with significant levels of SMR (＜0.5). For anti-HCV, the highest prevalence was in Shuiyu village (Dongshan Township) (90.5%, 38/42), where as a total of 12 villages had 0% prevalence. There were 69 villages with statistically significant levels of SMR (≧2) and 8 villages which had prevalence rates of more than 50%. 118 villages had significant levels of SMR (＜0.5). The numbers of high or low prevalence of HCV was much greater than for HBV. In prevalence of hypertransaminemia, the highest prevalence was in Shuiyu village (Dongshan Township) (54.8%, 23/42), followed by Nanhsi village (41.0%, 18/44). The lowest prevalence was in Tachou village (Hsinshih Township) (0%, 0/53). There were 15 villages with significant levels of SMR (≧2), and 18 villages with significant levels of SMR (＜0.5). The distributions of high and low prevalence of hypertransaminemia were similar to the prevalence of anti-HCV. Prevalence of anti-HCV at village level showed great diversity among each township. There was a high prevalence of anti-HCV in only a few villages in a township, but there were also all villages in a township. Conclusions: This study provides complete data for HBV, HCV and hepatitis in every village in Tainan County, and describes their geographic variations and distribution patterns. This important information should prove important to workers in public health.

關鍵字

B型肝炎表面抗原 ； C型肝炎抗體 ； ALT ； 地理差異性 ； 盛行率

並列摘要

Background and Aims: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the two major causes of liver disease deaths in Taiwan. The impact of HCV infection has increased since the effective prevention of HBV infection. Epidemiologic studies of HCV, in comparison with HBV, have hither to been incomplete in Taiwan. Previous studies for the prevalence of HCV were limited to small-scale community studies, and no large-scale community studies for the screening of HBV and HCV have been published before. The purpose of this study is to investigate the prevalence of HB surface antigen (HBsAg), anti-HCV antibody (anti-HCV) and hypertransaminemia levels in villages in Tainan county, and to analyze geographic variations among villages throughout the whole county. Patients and Methods: Health examinations were carried out by the Health Bureau of Tainan County in 533 villages in Tainan county between April and November 2004. Residents aged ＞40 years (n=56702; men/women: 17551/39151) were invited for a series of examinations, including HBsAg, anti-HCV and alanine transaminase (ALT). The upper normal limit of ALT levels is 40 IU/L. Standardized morbidity ratio (SMR) was used to analyse prevalences of HBsAg, anti-HCV and hypertransaminemia in village levels of Tainan county. The method is prevalences of HBsAg, anti-HCV and hypertransaminemia in village levels were divided by overall prevalences of these three parameters respectively. Goodness-of-fit test for chi-square was used to test the significance difference between the prevalences. A total of 13 villages were excluded because the number of subjects enrolled was not sufficient for the chi-square test. Results: The overall prevalence of HBsAg, anti-HCV and hypertransaminemia was 10.9%, 10.2% and 12.8% respectively. In village-specific prevalences of HBsAg, the highest prevalence was in Jianan village (Guantian Township) (28.0%, 7/25), and the lowest prevalences were found in Kanping village (Cigu Township), Chungjung village (Anding Township), Chinsha village (Sigang Township) and Shichao village (Longci Township) , (all at 0%). There were nine villages with significant levels of SMR (≧2), and 21 villages with significant levels of SMR (＜0.5). For anti-HCV, the highest prevalence was in Shuiyu village (Dongshan Township) (90.5%, 38/42), where as a total of 12 villages had 0% prevalence. There were 69 villages with statistically significant levels of SMR (≧2) and 8 villages which had prevalence rates of more than 50%. 118 villages had significant levels of SMR (＜0.5). The numbers of high or low prevalence of HCV was much greater than for HBV. In prevalence of hypertransaminemia, the highest prevalence was in Shuiyu village (Dongshan Township) (54.8%, 23/42), followed by Nanhsi village (41.0%, 18/44). The lowest prevalence was in Tachou village (Hsinshih Township) (0%, 0/53). There were 15 villages with significant levels of SMR (≧2), and 18 villages with significant levels of SMR (＜0.5). The distributions of high and low prevalence of hypertransaminemia were similar to the prevalence of anti-HCV. Prevalence of anti-HCV at village level showed great diversity among each township. There was a high prevalence of anti-HCV in only a few villages in a township, but there were also all villages in a township. Conclusions: This study provides complete data for HBV, HCV and hepatitis in every village in Tainan County, and describes their geographic variations and distribution patterns. This important information should prove important to workers in public health.

並列關鍵字

Hepatitis B surface antigen, HBsAg ； Anti-hepatitis C virus antibody, anti-HCV ； Alanine transaminase ； Geographic variation ； Prevalence