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Journal of the Korean Academy of Family Medicine 2002;23(4):510-520.
Published online April 1, 2002.
A study on the change of hepatitis B markers with the passage of time in nonvaccinees-A follow-up data of visitors in a health examination center for three years.
Sang Yeon Suh, Tai Woo Yoo, Bong Ryul Hu, Joung Soon Kim
1Department of Family Medicine, Catholic General Hospital, Korea.
2Department of Family Medicine, College of medicine, Seoul National University, Korea.
3Department of Epidemiology, Graduate School of Public Health, Seoul National University, Korea.
B 형 간염 예방 접종을 받지 않은 건강증진센터 수진자에서 3 년 후 B 형 간염 표지자의 변동
서상연, 유태우, 허봉렬, 김정순
1
2
3
Abstract
Background
: Korea is an epidemic area of hepatitis B. There are needs for longitudinal study to measure quantity of hepatitis B infection status in Korea. This study was designed to observe natural course of hepatitis B markers in the same person for three years. The objective of this study was to investigate incidence of new infection and persistence of previous infection.

Methods : The study subjects were clients who visited a health examination center in Seoul twice with an interval of three years, from 1995 to 2000. They replied as nonvaccinee on both occasions for hepatitis B by self-administered questionnaire. Hepatitis B markers were measured by radioimmunoassay on all visits. There were 103 subjects with 61 men and 42 women.

Results : The positive rate of hepatitis B surface antigen was 20.4% initially, which changed to 18.5% after three years. The positive rate of hepatitis B surface antibody was 61.2% initially, which increased to 66.0% after three years. The positive rates of hepatitis B surface antibody in men were 63.9% initially and 68.9% after three years, which showed statistically significant trend (p=0.08). The positive rate of hepatitis B core antibody was 89.3%, which remained the same after three years. There was no positive conversion case of hepatitis B surface antigen. The negative conversion rate of hepatitis B surface antigen was 2/63(3.2%). The positive conversion rate of hepatitis B surface antibody was 7/40(17.5%), and negative conversion rate of that was 2/63 (3.2%). The positive conversion rate of hepatitis B core antibody was 3/11(27.3%), and negative conversion rate of that was 3/92(3.3%).

Conclusion : Hepatitis B markers changed in the direction of infection incidence, rather than natural disappearance of markers in nonvacciness. The mechanism was postulated as occurrence of new infection mainly, but the possibility of double infection by variants of hepatitis B virus could not be ruled out. We confirmed that positive rate of hepatitis B marker in males was not only higher cross-sectionally, but also increased higher longitudinally. We suggest a follow-up study of hepatitis B markers to be performed because hepatitis B markers showed dynamic changes. We think the high risk groups of hepatitis B infection have a priority in follow-up studies.
초록
연구배경 : 우리나라는 B형 간염의 감염율이 높은 지역으로 감염상태의 계량적 측정을 위해 시간 경과를 따른 추적 연구가 필요하다. 본 연구의 목적은 동일인에서 3년 후에 B형 간염 표지자의 자연적 변화 양상을 관찰하여 감염의 지속과 발생을 알아보기 위함이다.

방법 : 연구대상은 1995년부터 2000년 사이에 서울 시내 일개 건강증진센터에 3년간의 간격을 두고 2회 내원한 수진자들이었다. 이 중 자가기입식 설문지에 2회 모두 B형 간염 예방 접종을 받지 않았다고 응답한 사람들을 선택하였다. B형 간염 표지자는 방사선면역측정법(radioimmunoassay)로 내원시마다 측정되었다. 연구대상자는 모두 103명으로 남성 61명, 여성 42명이었다.

결과 : B형 간염 표면 항원 양성률은 20.4%에서 3년 후 18.5%가 되었다. B형 간염 표면 항체 양성률을 61.2%에서 3년 후 66.0%로 증가하였다. B형 간염 표면 항체의 양성률은 남성에서 63.9%에서 68.9%로 통계적으로 유의한 증가 경향을 보였다(p=0.08). B형 간염 핵 항체 양성률은 89.3%에서 변하지 않았다. B형 간염 표면 항원의 양전례(positive conversion case)는 나타나지 않았다. Bgud 간염 표면 항원의 음전율은 2/63(3.2%)였다. B형 간염 표면 항체의 양전율은 7/40(17.5%)였고 이의 음전율은 2/63(3.2%)였다. B형 간염 핵 항체의 양전율은 3/11(27.3%)였으며 음전율은 3/92(3.3%)에 달했다.

결론 : 비접종군에서 B형 간염 표지자는 자연소실보다는 감염 발생율이 증가하는 양상으로 변동하였다. 그 기전으로는 새로운 감염의 발생이나 변이형에 의한 중복감염의 가능성이 추측된다. 본 연구를 통해 B형 간염 표지자가 남성과 같은 감염의 고위험군에서, 단면적 양성률만 높을 뿐 아니라 종주적 변화에서도 양성률이 높이 증가한다는 사실을 확인하였다. B형 간염 표지자는 시간경과에 따라 동적인 변화를 보이므로 이에 대한 추적 검사가 이루어져야 하며 감염의 고위험군에서 우선적으로 시행될 필요를 시사한다.
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