2006年浙江省温州市部分县(市、区)乙型病毒性肝炎病例诊断符合率调查分析

Analysis of diagnostic accordance rate of viral hepatitis B cases in Wenzhou,Zhejiang province,2006

目的了解2006年浙江省温州地区医疗机构乙型病毒性肝炎(乙肝)病例报告现状以及报告质量情况。方法定量调查和定性访谈相结合开展调查。利用2005年不同县(市、区)乙肝报告发病率高、中、低3个层次,选取3个县(市、区)内18家医疗单位,按国家诊断标准对报告的乙肝病例和实验室检验结果进行核实。选取18家医疗单位内从事传染病诊治的临床医生1名接受有关乙肝病例诊断分类、报告等问题的访谈。结果调查共抽取1017例乙肝病例进行核实,其中符合乙肝病例诊断的有598例,符合率为58.80%;乙肝诊断符合率以县(市、区)级医院最高,省级医院次之,乡镇卫生院最低。导致不符合诊断标准的最主要原因是乙肝病原携带者判定为乙肝病例,占81.38%。结论受访的临床医生对乙肝病例诊断分类、报告等知识的掌握不理想。乙肝诊断符合率过低,尤其在乡镇卫生院,加强开展医疗机构临床医生传染病诊疗水平及报告培训至关重要。

Objective The study was conducted to assess the performance and quality of hepatitis B cases report, provide the scientific basis for further improvement of the report system of hepatitis B in medical institutions. Methods Qualitative interviews and quantitative investigation were conducted. Eighteen medical institutions in 3 counties （cities/districts） with high, moderate and low reported hepatitis B incidence in 2005 were selected to verify the reported hepatitis B cases and the laboratory findings according to the national diagnostic criteria, and 1 doctor in charge of the diagnosis and management of infectious diseases in each of these medical institutions was interviewed about the diagnostic classification and report of hepatitis B cases. Results A total of 1017 cases were verified, among these cases, 598 were accordant with the national diagnosis criteria of hepatitis B case with the accordance rate of 58.80%. The highest diagnostic accordance rates were observed in county （city）-level hospitals, followed by provincial hospitals, and the lowest were in township health centers. The reason of disaccord was that the viral carriers of hepatitis B （81.38%） were diagnosed as hepatitis B cases. The interviewed doctors were unfamiliar with the diagnostic classification and report of hepatitis B cases. Conclusion The diagnosis accordance rate of hepatitis B was too low, particularly in township health centers. Therefore, it is vital to improve the training on the diagnosis and report of infectious diseases for the clinicians in medical institutions.