重庆市北碚区医疗机构病毒性肝炎诊断报告情况调查研究

Diagnosis and reporting of viral hepatitis in hospitals in Beibei,Chongqing

目的对重庆市北碚区医疗机构病毒性肝炎的诊断报告情况进行评价,探讨诊断报告中存在问题的原因,提出科学的防控建议。方法通过问卷调查了解可疑肝炎病例的临床表现,采集血液由疾控部门进行检验,对病例诊断进行判断,查询重庆市北碚区肝炎病例报告情况,对该地区医疗机构肝炎诊断报告情况进行分析,对医疗机构与疾控部门的实验室检测结果进行对比。结果共确诊病毒性肝炎217例,其中急性乙型病毒性肝炎(乙肝)116例,慢性乙肝88例,戊型病毒性肝炎(戊肝)5例,甲型病毒性肝炎(甲肝)3例。通过与医疗机构的网络报告进行对比,发现47例急性乙肝被医疗机构报告为慢性乙肝;医疗机构报告的慢性乙肝病例的阳性预测值仅为47%,而急性乙肝的阴性预测值也仅为52%,医疗机构仅对47%的可疑病例开展了抗乙肝病毒核心抗原抗体(抗-HBcIgM)检测,且其阳性率明显低于疾病预防控制中心(χ2=13.00,P<0.01)。结论重庆市北碚区医疗机构病毒性肝炎诊断报告存在较大问题,建议临床医生更多运用抗-HBc IgM检测来辅助临床诊疗,并且要采取措施提高检测准确率,同时还要进一步提高医务人员传染病报告的意识,卫生行政部门也应加强督导检查。

Objective To evaluate the diagnosis and reporting of viral hepatitis in hospitals in Beibei district, Chongqing, explore the cause of related problems and make recommendation on the prevention and control of viral hepatitis. Methods The questionnaire survey was conducted among suspected cases of viral hepatitis about their clinical manifestation and blood samples were taken from them for the detection by CDC to confirm the clinical diagnosis. The survey of viral hepatitis reporting in local hospitals was conducted. Results A total of 217 viral hepatitis cases were confirmed, including 116 acute hepatitis B cases, 88 chronic hepatitis B cases, 5 hepatitis E cases and 3 hepatitis A cases. Compared with the case reporting in hospitals, it was found that 47 acute hepatitis B cases were misreported as chronic ones. The positive predictive value of chronic hepatitis B in hospitals was only 47 %, and the negative predictive value of acute hepatitis B was only 52% too. Anti HBc IgM detection was conducted for only 47% of the suspected cases of viral hepatitis in hospitals, and the positive rate was significantly lower than that in CDC. （X2 = 13.00, P 〈 0.01 ）. Conclusion Problems still exist in the diagnosis and reporting of viral hepatitis in the hospitals in Beibei. It is suggested that the hospitals should conduct anti HBc IgM detection to confirm clinical diagnosis, take effective measures to improve the detection accuracy and highlight the responsibility of medical staff to report communicable disease cases, and local health administration should strengthen the supervision of viral hepatitis reporting.