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Article(id=1321169753079660978, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169668631548508, articleNumber=null, orderNo=null, doi=10.11847/zgggws1147013, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1737820800000, receivedDateStr=2025-01-26, revisedDate=1752336000000, revisedDateStr=2025-07-13, acceptedDate=1753977600000, acceptedDateStr=2025-08-01, onlineDate=1792921015281, onlineDateStr=2026-10-25, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921015281, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921015281, creator=13701087609, updateTime=1792921015281, updator=13701087609, issue=Issue{id=1321169668631548508, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='9', pageStart='1025', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792920995147, creator='13701087609', updateTime=1792920995147, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1069, endPage=1073, ext={EN=ArticleExt(id=1321169753268404659, articleId=1321169753079660978, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Hepatitis C epidemic characteristics in Shanghai, 2020–2023: a surveillance data analysis, columnId=1321169730682077453, journalTitle=Chinese Journal of Public Health, columnName=Special Report — United in the Fight Against Hepatitis C, runingTitle=null, highlight=null, articleAbstract=
Objective

To systematically analyze the integrated surveillance data of hepatitis C (HC) in Shanghai and provide a scientific basis for the elimination of HC.

Methods

The reported HC cases, hepatitis C virus (HCV) genotypes, and sentinel surveillance data were collected based on the integrated HC surveillance work in Shanghai from 2020 to 2023. The incidence trend, distribution, HCV genotypes, and high-risk/key populations of HC in Shanghai were analyzed.

Results

The reported incidences of acute and chronic HC in Shanghai from 2020 to 2023 were 0.04/100 000 and 6.93/100 000, respectively. The reported chronic cases were mainly males, middle-aged and elderly people, and downtown residents. Genotypes 1b (40.36%), 3b (14.80%), 3a (11.43%), 6a (10.09%), and 6n (6.05%) were the principal subtypes of HCV. The HCV antibody-positive rate in drug users, family members of HC patients, and people who died of liver disease were 31.88%, 10.00%, and 6.00%, respectively, which were significantly higher than that in other high-risk/key populations. The departments of hepatology (4.79%), traditional Chinese medicine/acupuncture and moxibustion (2.53%), general outpatient (1.85%), hemodialysis (1.58%), and infectious diseases (1.41%) were the key departments of medical institutions with higher HCV-antibody positive rates.

Conclusions

HC was low-epidemic in Shanghai from 2020 to 2023, with higher infection rates observed among drug users and family members of HC patients. Optimization of the integrated surveillance system for HC is of great value for understanding the epidemiological characteristics, infection status of high-risk/key populations, rational allocation of medical and health resources, and promoting the elimination of HC.

, authors=Kaiyun CHEN1, Zuping GUO2, Di XU1, Wei WANG3, Xin SHEN1, Hong REN1, authorsList=Kaiyun CHEN, Zuping GUO, Di XU, Wei WANG, Xin SHEN, Hong REN, authorCompany=null, correspAuthors=Hong REN, authorNote=null, correspAuthorsNote=
REN Hong, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169753704612276, articleId=1321169753079660978, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=2020—2023年上海市丙型肝炎流行特征分析, columnId=1321169730837266703, journalTitle=中国公共卫生, columnName=专题报道——积极行动，共抗丙肝, runingTitle=null, highlight=null, articleAbstract=
目的

系统分析上海市丙型肝炎（丙肝）综合监测数据，为上海市推动丙肝危害消除工作提供科学依据。

方法

基于上海市丙肝综合监测工作，获得2020—2023年丙肝病例报告、病原学分型、哨点监测等数据，分析本市丙肝的发病趋势和分布特征、基因分型、高风险/重点人群的感染状况。

结果

上海市2020—2023年急性丙肝年均报告发病率为0.04/10万，慢性丙肝年均报告发病率为6.93/10万，慢性病例以男性、中老年和中心城区人群为主。基因亚型中，1b（占40.36%）、3b（占14.80%）、3a（占11.43%）、6a（占10.09%）和6n（占6.05%）亚型为HCV流行的主要型别。吸毒者（31.88%）、丙肝患者家属（10.00%）和因肝病死亡人群（6.00%）的HCV抗体阳性率，显著高于其他高风险/重点人群。就诊人群的HCV抗体阳性率检测结果显示，肝病科（4.79%）、中医/针灸科（2.53%）、全科门诊（1.85%）、血透室（1.58%）和感染科/传染科（1.41%）是医疗机构发现丙肝感染者的重点科室。

结论

2020—2023年上海市丙肝呈低流行水平，吸毒者、丙肝患者家属等人群中感染率较高。进一步优化和完善丙肝综合监测系统，对及时掌握丙肝的流行特征、高风险/重点人群的感染状况，合理配置医疗卫生资源具有重要的公共卫生意义。

, authors=陈恺韵1, 郭足平2, 徐迪1, 王葳3, 沈鑫1, 任宏1, *, *, authorsList=陈恺韵, 郭足平, 徐迪, 王葳, 沈鑫, 任宏, authorCompany=null, correspAuthors=任宏, authorNote=

陈恺韵（1993—），主管医师，硕士，研究方向：病毒性肝炎防制

, correspAuthorsNote=
任宏，E-mail：
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陈恺韵（1993—），主管医师，硕士，研究方向：病毒性肝炎防制

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Average annual reported incidence of hepatitis C from 2020 to 2023 in Shanghai

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年份人口数/人急性慢性总计
病例数/例发病率/（1/10万）病例数/例发病率/（1/10万）病例数/例发病率/（1/10万）
202024 281 386110.051 7117.051 7227.09
202124 870 889150.062 2198.922 2348.98
202224 890 01090.041 2114.871 2204.90
202324 745 58890.041 7056.891 7146.93
合计98 787 873 a440.046 8466.936 8906.97
), ArticleFig(id=1321169758502896103, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169753079660978, language=CN, label=表1, caption=

2020—2023年上海市丙肝年均报告发病率

, figureFileSmall=null, figureFileBig=null, tableContent=
年份人口数/人急性慢性总计
病例数/例发病率/（1/10万）病例数/例发病率/（1/10万）病例数/例发病率/（1/10万）
202024 281 386110.051 7117.051 7227.09
202124 870 889150.062 2198.922 2348.98
202224 890 01090.041 2114.871 2204.90
202324 745 58890.041 7056.891 7146.93
合计98 787 873 a440.046 8466.936 8906.97
), ArticleFig(id=1321169758574199272, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169753079660978, language=EN, label=Tab.2, caption=

Sociodemographic characteristics of reported hepatitis C cases from 2020 to 2023 in Shanghai

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特征分类2020年（n=1 722）2021年（n=2 234）2022年（n=1 220）2023年（n=1 714）合计（n=6 890）
急性慢性急性慢性急性慢性急性慢性急性慢性
性别男性7（0.06）1 096（8.82）11（0.09）1 443（11.21）6（0.05）804（6.23）4（0.03）1 092（8.50）28（0.05）4 435（8.69）
女性4（0.03）615（5.19）4（0.03）776（6.47）3（0.03）407（3.40）5（0.04）613（5.15）16（0.03）2 411（5.05）
年龄组/岁0～<401（0.01）271（2.93）5（0.05）371（3.91）1（0.01）160（1.72）2（0.02）196（2.18）9（0.02）998（2.70）
40～<657（0.07）1 139（11.47）10（0.10）1 478（14.54）8（0.08）867（8.88）5（0.05）1 243（13.46）30（0.08）4 727（12.09）
≥653（0.06）301（5.91）0（0.00）370（7.09）0（0.00）184（3.15）2（0.03）266（4.07）5（0.02）1 121（4.94）
地区中心城区3（0.04）708（10.26）8（0.12）899（13.45）2（0.03）452（6.78）2（0.03）576（9.07）15（0.06）2 635（9.91）
郊区8（0.05）1 003（5.77）7（0.04）1 320（7.26）7（0.04）759（4.16）7（0.04）1 129（6.14）29（0.04）4 211（5.83）
), ArticleFig(id=1321169758666473961, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169753079660978, language=CN, label=表2, caption=

2020—2023年上海市报告丙肝病例社会人口学分布特征/例（1/10万）

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特征分类2020年（n=1 722）2021年（n=2 234）2022年（n=1 220）2023年（n=1 714）合计（n=6 890）
急性慢性急性慢性急性慢性急性慢性急性慢性
性别男性7（0.06）1 096（8.82）11（0.09）1 443（11.21）6（0.05）804（6.23）4（0.03）1 092（8.50）28（0.05）4 435（8.69）
女性4（0.03）615（5.19）4（0.03）776（6.47）3（0.03）407（3.40）5（0.04）613（5.15）16（0.03）2 411（5.05）
年龄组/岁0～<401（0.01）271（2.93）5（0.05）371（3.91）1（0.01）160（1.72）2（0.02）196（2.18）9（0.02）998（2.70）
40～<657（0.07）1 139（11.47）10（0.10）1 478（14.54）8（0.08）867（8.88）5（0.05）1 243（13.46）30（0.08）4 727（12.09）
≥653（0.06）301（5.91）0（0.00）370（7.09）0（0.00）184（3.15）2（0.03）266（4.07）5（0.02）1 121（4.94）
地区中心城区3（0.04）708（10.26）8（0.12）899（13.45）2（0.03）452（6.78）2（0.03）576（9.07）15（0.06）2 635（9.91）
郊区8（0.05）1 003（5.77）7（0.04）1 320（7.26）7（0.04）759（4.16）7（0.04）1 129（6.14）29（0.04）4 211（5.83）
), ArticleFig(id=1321169758733582826, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169753079660978, language=EN, label=Tab.3, caption=

Genotype distribution of HCV from 2020 to 2023 in Shanghai

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年份采样数/份核酸阳性分
型成功数/份		基因亚型
1 b3 b3 a6 a6 n1 a2 a其他a
检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%
20202361888042.552513.30189.572111.1794.7942.1352.662613.83
20213142517429.484317.132710.763112.35187.17145.58124.783212.75
20222252139042.253114.553114.55125.63167.51146.5773.29125.63
202327824011648.333313.752610.832610.83114.5852.08104.17135.42
合计1 05389236040.3613214.8010211.439010.09546.05374.15343.81839.31
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2020—2023年上海市HCV基因分型监测结果

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年份采样数/份核酸阳性分
型成功数/份		基因亚型
1 b3 b3 a6 a6 n1 a2 a其他a
检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%		检出
数/份		构成
比/%
20202361888042.552513.30189.572111.1794.7942.1352.662613.83
20213142517429.484317.132710.763112.35187.17145.58124.783212.75
20222252139042.253114.553114.55125.63167.51146.5773.29125.63
202327824011648.333313.752610.832610.83114.5852.08104.17135.42
合计1 05389236040.3613214.8010211.439010.09546.05374.15343.81839.31
), ArticleFig(id=1321169760457441774, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169753079660978, language=EN, label=Tab.4, caption=

Detection of HCV antibodies in high-risk/key populations of hepatitis C from 2020 to 2023 in Shanghai

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人群分类2020202120222023总计
筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%
因肝病死亡人群——————3925.136146.5610066.00
肾透析人群——————40020.501 218100.821 618120.74
体检人群——————2 137120.562 08940.194 226160.38
侵入性诊疗人群——————80020.252 517180.723 317200.60
HIV感染人群——————400123.0015032.00550152.73
医护人员79000.0058900.0090600.0095260.633 23760.19
丙肝患者家属——————49510.206169.841101110.00
无偿献血人群2 02000.002 02120.102 022130.644 000130.3310 063280.28
吸毒者1 22036429.842 27368530.142 19171832.771 21043135.626 8942 19831.88
暗娼4 585220.485 137190.374 350200.464 426160.3618 498770.42
男男性行为者40510.2540100.0040130.7580320.252 01060.30
性病门诊男
性就诊者		3 202160.503 21190.283 25590.283 216100.3112 884440.34
流动人群4 112120.294 292150.354 193140.334 089130.3216 686540.32
青年学生———1 62800.001 71600.001 61400.004 95800.00
肺结核患者40020.5040020.5040020.500——1 20060.50
合计16 7344172.4919 9527323.6723 2598143.5026 4065362.0386 3512 4992.89
), ArticleFig(id=1321169760545522159, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169753079660978, language=CN, label=表4, caption=

2020—2023年上海市丙肝高风险/重点人群HCV抗体检出情况

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人群分类2020202120222023总计
筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%筛查数/人次阳性数/人次阳性率/%
因肝病死亡人群——————3925.136146.5610066.00
肾透析人群——————40020.501 218100.821 618120.74
体检人群——————2 137120.562 08940.194 226160.38
侵入性诊疗人群——————80020.252 517180.723 317200.60
HIV感染人群——————400123.0015032.00550152.73
医护人员79000.0058900.0090600.0095260.633 23760.19
丙肝患者家属——————49510.206169.841101110.00
无偿献血人群2 02000.002 02120.102 022130.644 000130.3310 063280.28
吸毒者1 22036429.842 27368530.142 19171832.771 21043135.626 8942 19831.88
暗娼4 585220.485 137190.374 350200.464 426160.3618 498770.42
男男性行为者40510.2540100.0040130.7580320.252 01060.30
性病门诊男
性就诊者		3 202160.503 21190.283 25590.283 216100.3112 884440.34
流动人群4 112120.294 292150.354 193140.334 089130.3216 686540.32
青年学生———1 62800.001 71600.001 61400.004 95800.00
肺结核患者40020.5040020.5040020.500——1 20060.50
合计16 7344172.4919 9527323.6723 2598143.5026 4065362.0386 3512 4992.89
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2020—2023年上海市丙型肝炎流行特征分析
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陈恺韵 1 , 郭足平 2 , 徐迪 1 , 王葳 3 , 沈鑫 1 , 任宏 1, *, *
中国公共卫生 | 专题报道——积极行动，共抗丙肝 2025,41(9): 1069-1073
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中国公共卫生 |专题报道——积极行动，共抗丙肝 2025 , 41 (9) : 1069 -1073
2020—2023年上海市丙型肝炎流行特征分析
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陈恺韵1, 郭足平2, 徐迪1, 王葳3, 沈鑫1, 任宏1, *, *
作者信息
  • 1上海市疾病预防控制中心结核病与艾滋病防治所，上海 200336
  • 2上海市虹口区疾病预防控制中心（上海市虹口区卫生健康监督所），上海 200082
  • 3上海市疾病预防控制中心病原检定所，上海 200336
通讯作者:
任宏，E-mail：
作者简介:

陈恺韵（1993—），主管医师，硕士，研究方向：病毒性肝炎防制

Hepatitis C epidemic characteristics in Shanghai, 2020–2023: a surveillance data analysis
Kaiyun CHEN1, Zuping GUO2, Di XU1, Wei WANG3, Xin SHEN1, Hong REN1
Affiliations
  • 1Institute for Tuberculosis and AIDS Control & Prevention, Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
  • 2Hongkou District Center for Disease Control & Prevention (Hongkou District Health Supervision Institute), Shanghai 200082, China
  • 3Pathogen Detection Institute, Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
    • Corresponding Author:
    REN Hong, E-mail:
出版时间: 2025-09-10 doi: 10.11847/zgggws1147013
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摘要
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目的

系统分析上海市丙型肝炎（丙肝）综合监测数据，为上海市推动丙肝危害消除工作提供科学依据。

方法

基于上海市丙肝综合监测工作，获得2020—2023年丙肝病例报告、病原学分型、哨点监测等数据，分析本市丙肝的发病趋势和分布特征、基因分型、高风险/重点人群的感染状况。

结果

上海市2020—2023年急性丙肝年均报告发病率为0.04/10万，慢性丙肝年均报告发病率为6.93/10万，慢性病例以男性、中老年和中心城区人群为主。基因亚型中，1b（占40.36%）、3b（占14.80%）、3a（占11.43%）、6a（占10.09%）和6n（占6.05%）亚型为HCV流行的主要型别。吸毒者（31.88%）、丙肝患者家属（10.00%）和因肝病死亡人群（6.00%）的HCV抗体阳性率，显著高于其他高风险/重点人群。就诊人群的HCV抗体阳性率检测结果显示，肝病科（4.79%）、中医/针灸科（2.53%）、全科门诊（1.85%）、血透室（1.58%）和感染科/传染科（1.41%）是医疗机构发现丙肝感染者的重点科室。

结论

2020—2023年上海市丙肝呈低流行水平，吸毒者、丙肝患者家属等人群中感染率较高。进一步优化和完善丙肝综合监测系统，对及时掌握丙肝的流行特征、高风险/重点人群的感染状况，合理配置医疗卫生资源具有重要的公共卫生意义。

丙型肝炎  /  高风险/重点人群  /  基因分型  /  流行特征  /  上海市
Objective

To systematically analyze the integrated surveillance data of hepatitis C (HC) in Shanghai and provide a scientific basis for the elimination of HC.

Methods

The reported HC cases, hepatitis C virus (HCV) genotypes, and sentinel surveillance data were collected based on the integrated HC surveillance work in Shanghai from 2020 to 2023. The incidence trend, distribution, HCV genotypes, and high-risk/key populations of HC in Shanghai were analyzed.

Results

The reported incidences of acute and chronic HC in Shanghai from 2020 to 2023 were 0.04/100 000 and 6.93/100 000, respectively. The reported chronic cases were mainly males, middle-aged and elderly people, and downtown residents. Genotypes 1b (40.36%), 3b (14.80%), 3a (11.43%), 6a (10.09%), and 6n (6.05%) were the principal subtypes of HCV. The HCV antibody-positive rate in drug users, family members of HC patients, and people who died of liver disease were 31.88%, 10.00%, and 6.00%, respectively, which were significantly higher than that in other high-risk/key populations. The departments of hepatology (4.79%), traditional Chinese medicine/acupuncture and moxibustion (2.53%), general outpatient (1.85%), hemodialysis (1.58%), and infectious diseases (1.41%) were the key departments of medical institutions with higher HCV-antibody positive rates.

Conclusions

HC was low-epidemic in Shanghai from 2020 to 2023, with higher infection rates observed among drug users and family members of HC patients. Optimization of the integrated surveillance system for HC is of great value for understanding the epidemiological characteristics, infection status of high-risk/key populations, rational allocation of medical and health resources, and promoting the elimination of HC.

hepatitis C  /  high-risk/key populations  /  genotypes  /  epidemic characteristics  /  Shanghai
陈恺韵, 郭足平, 徐迪, 王葳, 沈鑫, 任宏. 2020—2023年上海市丙型肝炎流行特征分析. 中国公共卫生, 2025 , 41 (9) : 1069 -1073 . DOI: 10.11847/zgggws1147013
Kaiyun CHEN, Zuping GUO, Di XU, Wei WANG, Xin SHEN, Hong REN. Hepatitis C epidemic characteristics in Shanghai, 2020–2023: a surveillance data analysis[J]. Chinese Journal of Public Health, 2025 , 41 (9) : 1069 -1073 . DOI: 10.11847/zgggws1147013
正文
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丙型肝炎（以下简称“丙肝”）是由丙肝病毒（HCV）感染引起的、以肝脏病变为主的慢性传染性疾病，以隐匿性感染为主，约55%～85%的感染者会发展为慢性肝炎，极易进展为肝硬化和肝癌，是全球和我国重要的公共卫生问题之一[1–4]。2016年上海市初步建成涵盖“丙肝患者–高风险/重点人群–社区健康人群”的多维度丙肝综合监测系统[5]，为及时掌握丙肝的流行特征、识别和确定高风险/重点人群、合理布局定点医院和分配诊疗资源[6]、制定和完善丙肝消除策略提供有力保障和技术支撑。2020年上海市在此基础上进一步融合了国家丙肝哨点监测和艾滋病监测的相关内容，以“多病共防”为抓手[7]，进一步拓展高风险/重点人群的监测范围。本次研究主要系统分析了2020—2023年的丙肝综合监测结果，以了解上海市丙肝流行特征，为推动丙肝危害消除工作提供科学依据。
1　资料与方法
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1.1　资料来源
1.1.1　病例监测
2020—2023年丙肝病例报告数据来源于中国疾病预防控制信息系统，按照发病日期纳入所有现住地为上海市、病例分类为确诊病例和临床诊断病例的丙肝病例，病例诊断根据《丙型肝炎诊断：WS 213—2018》执行；相关人口学资料来源于上海市公安局。
1.1.2　病原学监测
选择35家综合性医院和5家传染病专科医院共同构成本市丙肝病原学监测网络。于2020—2023年，每年随机抽取每家医院新报告且未经治疗的丙肝患者5～10例，共1 053例，每例采集全血3 mL（血清2 mL），送上海市疾病预防控制中心检测基因分型。采用HCV核酸测定试剂盒（上海之江生物科技股份有限公司），经荧光PCR法进行核酸定性检测；用RT-PCR法对出现阳性扩增曲线（核酸检测结果阳性）的样本，分别采用HCV的NS5B和5'UTR基因扩增试剂盒（上海伯杰医疗科技有限公司）实施基因扩增与测序分析确定基因分型。2个片段基因分型结果一致即确定为相应基因亚型，样本量不足则以单片段基因分型结果为准。检测设备使用SSNP-9600 A全自动核酸提取仪（江苏硕世生物科技股份有限公司）与LightCycler 480荧光定量PCR仪（美国罗氏诊断）。
1.1.3　高风险/重点人群监测
2020—2023年，上海市在开展覆盖医护人员、丙肝患者家属、无偿献血人群、艾滋病哨点人群（吸毒者、暗娼、男男性行为者、性病门诊男性就诊者、流动人群、青年学生和肺结核患者）等10类丙肝高风险/重点人群监测项目的基础上[5]，按照《全国丙型肝炎哨点监测实施方案（试行）》（2022年版）进一步对医疗机构就诊人群、因肝病死亡人群、肾透析人群、体检人群、侵入性诊疗人群和HIV感染人群等6类人群开展监测。共纳入16类监测对象、184 562人次开展丙肝高风险/重点人群监测。其中，艾滋病哨点人群监测结果（7类）来源于国家艾滋病防治工作信息系统；丙肝患者家属监测结果来源于上海市慢性肝炎社区健康管理项目；其余8类人群的监测结果，包括基本信息和HCV抗体检测结果等，由监测单位完成检测并直接报告提供。
1.2　统计学分析
使用Epi Data 3.1软件双份录入并逻辑核查原始数据，核对无误后建立丙肝监测信息数据库。使用SPSS 23.0软件描述性统计分析数据；采用χ2检验比较计数资料，双侧检验α=0.05。
2　结　果
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2.1　病例监测
2.1.1　报告发病情况（表1）
2020—2023年，上海市报告急性丙肝病例44例，年均报告发病率0.04/10万（χ2=0.729，P=0.393）；报告慢性丙肝病例6 846例，年均报告发病率为6.93/10万，呈波动趋势（χ2=37.122，P<0.05）。
2.1.2　分布特征（表2）
2020—2023年，上海市急性、慢性丙肝报告发病性别比分别为1.75:1和1.84:1；其中，慢性丙肝男性年均报告发病率（8.69/10万）高于女性（5.05/10万），差异有统计学意义（χ2=470.658，P<0.05）。急性（68.18%）、慢性（69.05%）患者发病年龄均集中在40～<65岁年龄组；急性丙肝散在发生，无相对高发区域；中心城区慢性丙肝年报告发病率（9.91/10万）高于郊区（5.83/10万），差异有统计学意义（χ2=466.219，P<0.05）。
2.2　病原学监测
2.2.1　基本情况
2020—2023年，上海市共监测丙肝初诊住院病例1 053例，其中男性698例、平均年龄（51.12±11.63）岁，女性355例、平均年龄（53.59±13.19）岁；中心城区440例、郊区613例。
2.2.2　基因分型（表3）
共采集新报告且未经治疗的丙肝患者血清样本1 053份，其中核酸检测阳性且成功基因分型892份、占84.71%；共检测到GT1、GT2、GT3、GT6型4个型别20个亚型，其中，GT1型421例、占47.20%，GT3型235例、占26.35%，GT6型167例、占18.72%；GT1、GT3型的构成比在各年份间呈波动趋势，GT6型的构成比呈上升趋势。基因亚型方面，1b亚型360例、占40.36%，3b亚型132例、占14.80%，3 a亚型102例、占11.43%，6a亚型90例、占10.09%，6 n亚型54例、占6.05%。
2.3　高风险/重点人群监测
2.3.1　医疗机构就诊人群监测
2022—2023年，对57家医疗机构重点科室就诊者共监测了579 558人次的丙肝感染状况，其中HCV抗体阳性4 051人次、检出率0.70%；随机抽取7家医疗机构按科室分析感染率，共99 011人次的重点科室就诊者中，HCV抗体阳性检出率为0.67%，与57家医疗机构重点科室就诊者检测结果差异无统计学意义（χ2=0.785，P=0.376）。其中，肝病科（4.79%）、中医/针灸（2.53%）、全科门诊（1.85%）、血透室（1.58%）、感染科/传染科（1.41%）、消化科（0.93%）、皮肤性病科（0.80%）、内科（0.68%）的HCV抗体阳性率高于平均水平，妇产科（0.29%）、口腔科（0.23%）、肿瘤科（0.22%）、儿科（0.00）和医疗整容美容科（0.00）等科室的HCV抗体阳性率较低。
2.3.2　其余15类监测对象（表4）
其余共监测了86 351人次的15类高危/重点人群的丙肝感染状况，HCV抗体阳性率2.89%（2 499/86 351）。其中，吸毒者HCV抗体阳性率最高（31.88%，2 198/6 894），其次为丙肝患者家属（10.00%，11/110）、因肝病死亡人群（6.00%，6/100）、HIV感染人群（2.73%，15/550）、肾透析人群（0.74%，12/1 618）、侵入性诊疗人群（0.60%，20/3 317）；结核病患者、暗娼、体检人群、性病门诊男性就诊者、流动人口、男男性行为者、献血者和医护人员的HCV抗体阳性率均在0.50%及以下。
3　讨　论
收起
2020—2023年上海市急性丙肝年均报告发病率趋于稳定；慢性丙肝年均报告发病率呈波动趋势，其中2022年最低，可能与新冠疫情防控期间医疗机构就诊量下降有关，但整体评估本阶段报告发病水平，相较于上海市2014—2019年发病率亦呈下降趋势[5]。急性和慢性丙肝的报告病例均以中老年患者为主，与2015—2021年全国报告数据基本一致[8]。中老年群体发生接受侵入性诊疗操作、曾输注未经严格筛查的血液制品等丙肝感染高危行为的频率较高。此外，还可能受到隐匿性感染造成的病例累积效应、中老年人就医需求较高而更容易被检出等因素的影响[4,9–10]，导致更多中老年病例被检出发现。中老年人群作为丙肝感染和传播的重点人群，为其提供更便捷的就医条件，如下沉丙肝诊疗服务至社区，可提高医疗服务可及性，降低疾病经济负担，提升患者健康水平[11–12]。
本次研究发现，1b、3b、3a、6a、6n等吸毒相关亚型为目前上海市HCV流行的主要型别，与2014—2019年相比[5]，3a、3b和6 a亚型等吸毒相关基因型的构成比呈现上升趋势[13]。近年来，上海市卫生行政部门与上海市司法系统紧密合作，在戒毒所和监狱等监管场所先后启动丙肝免费治疗和危害消除工作；另外，也依托禁毒社工等对社区戒毒和社区康复人群及其家属探索开展感染者发现、转介及治疗工作。如2021年宝山区、静安区和徐汇区探索开展了社区戒毒与社区康复人群感染率调查[14]；2023年，虹口区探索了以禁毒志愿者为核心的“团购式”筛查与治疗服务，通过核心志愿者的动员促进患者治疗意愿转化为治疗行动，该人群治疗率达86.8%。但吸毒人群基数大，感染型别多为难治基因型[15]，且基因3型对肝功能及胆红素代谢影响较严重[16]。因此，医疗机构应严格按照指南要求，在抗病毒治疗前进行患者的基因分型检测、规范诊治；针对GT3型代偿期肝硬化或者3b亚型患者应增加利巴韦林治疗[2]。
2020—2023年除医疗机构重点科室就诊者外，15类高风险/重点人群的HCV抗体阳性率为2.89%，高于2014—2019年上海市的高风险/重点人群监测结果2.22%[5]。其中，吸毒者感染率31.88%，与本研究病原学基因型分布结果相匹配。丙肝患者家属感染率仅次于吸毒者，提示家庭内干预的重要性，后续将进一步扩大样本量优化监测，并同步将家属筛查纳入丙肝社区健康管理项目。HIV感染人群丙肝感染率也显著高于其他人群，有研究表明，对HIV/HCV共感染患者进行直接抗病毒药物治疗将有利于患者免疫功能和肝功能恢复[17]，提示在HIV人群中开展HCV筛查实行“多病共防”的重要性。肝病科、感染科/传染科、消化科多因肝病相关症状而就诊，血透室、皮肤性病科多由于相关危险因素暴露而受检，故检出率较高，提示上述科室是医疗机构发现丙肝感染者的主要来源。综上，提示医疗机构应加强预检分诊，对诊疗过程中发现的丙肝抗体阳性者落实核酸检测，使丙肝患者得到及时确诊后启动治疗，并做好“院内”和“院间”转诊转介工作，将感染者引导至丙肝定点门诊诊疗；在丙肝疾病负担较高地区，针对无感染科的综合性医院，可考虑将消化科纳入丙肝定点诊疗体系，探索由消化科主导的患者筛查与诊疗管理流程；此外，需做好医源性暴露和院内感染控制。
本次研究还存在一定局限性：首先，医疗机构就诊者和艾滋病哨点监测人群统计单位为人次数，可能存在重复统计情况，累计感染率的统计可能会高于真实水平；其次，丙肝患者家属、因肝病死亡及部分重点科室的监测数量较低，后续将扩大样本数量，继续优化监测工作；最后，上海市医疗机构就诊者等6类人群的丙肝专病哨点监测工作起步于2022年，受监测点选点设置因素影响，本研究的部分结果可能与实际情况存在差异，下一步将完善本市监测网络设置，保障监测数据质量。
综上所述，进一步优化和完善丙肝综合监测系统，对于及时掌握丙肝的流行特征、高风险/重点人群的感染状况，合理配置医疗卫生资源具有重要的公共卫生意义。今后可通过提升高风险/重点人群的诊疗服务可及性，加强监测与干预，以及完善基于医院重点科室的“院内”和“院间”转诊转介机制，规范诊疗流程，推进丙肝消除工作。

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doi: 10.11847/zgggws1147013
  • 接收时间：2025-01-26
  • 首发时间：2026-10-25
  • 出版时间：2025-09-10
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  • 收稿日期：2025-01-26
  • 修回日期：2025-07-13
  • 录用日期：2025-08-01
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    1上海市疾病预防控制中心结核病与艾滋病防治所，上海 200336
    2上海市虹口区疾病预防控制中心（上海市虹口区卫生健康监督所），上海 200082
    3上海市疾病预防控制中心病原检定所，上海 200336

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Number of
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Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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