2013年中国乙型肝炎监测试点数据分析

Analysis of the hepatitis B report data on pilot surveillance in 200 counties in China, 2013

目的：分析中国乙型肝炎监测试点县（区）附卡信息及疑似急性乙型肝炎病例标本乙型肝炎核心抗体（抗-HBc） IgM复核结果，了解全国乙型肝炎监测试点情况。方法选取2013年中国200个乙型肝炎监测试点县（区）全国法定传染病报告系统（NNDRS）中报告的乙型肝炎病例作为研究对象，共63641例。所有报告乙型肝炎病例均填写附卡信息。对疑似急性乙型肝炎病例采集静脉血5 ml，统一进行抗-HBc IgM检测；结合报告卡附卡信息及抗-HBc IgM检测结果，对疑似急性乙型肝炎病例进行复核诊断。结果63641例乙型肝炎病例中附卡填写乙型肝炎表面抗原（HBsAg）阳性时间6个月内阴转阳者1723例，其中报告为慢性乙型肝炎735例，占42.66%；抗-HBc IgM检测阳性者4582例，其中报告为急性乙型肝炎2436例，占53.16%，报告为慢性乙型肝炎1829例，占39.92%；肝穿刺和恢复期血清变化的有效填写数分别是579例和4961例，分别占总报告病例数的0.91%和7.80%。对4302例疑似急性乙型肝炎进行重新复核诊断，最终诊断为急性乙型肝炎1197例，占27.82%，慢性乙型肝炎2590例，占60.20%。结论临床医生未能充分利用报告卡附卡信息对乙型肝炎病例进行诊断；对抗-HBc IgM阳性的疑似急性乙型肝炎病例应重视随访，运用HBsAg指标变化进一步区分急慢性乙型肝炎。

Objective To analyze the information of the supplementary card for hepatitis B and the laboratory confirmed result of immunoglobulin M antibody to hepatitis B virus （HBV） Core Antigen （anti-HBc IgM） for the suspected acute hepatitis B to evaluate the hepatitis B report data on pilot surveillance. Methods 200 counties were established in China for hepatitis B pilot surveillance and 63 641 cases were reported. We added a supplementary card in National Notificable Disease Reporting System （NNDRS） and all the reported hepatitis B cases in NNDRS were required to fill the supplementary card. Venous blood 5 ml was collected and a confirmed test of anti-HBc IgM was made for suspected acute hepatitis B. We made confirmed diagnosis for the suspected acute hepatitis B according to the supplementary card information of the reporting card and the confirmed test result of anti-HBc IgM. Results 63 641 hepatitis B cases were reported in 200 hepatitis B pilot surveillance counties in 2013. Among 1 723 cases which were filled with the HBsAg positive within six months in supplementary card, 735 cases were reported as chronic hepatitis B, the proportion was 42.66%. Among 4 582 cases which were filled with anti-HBc IgM positive in supplementary card, 2 436 cases were reported as acute hepatitis B , the proportion was 53.16%. 1 829 cases were reported as chronic hepatitis B, the proportion was 39.92%. The validity cases of the information for liver puncture and the HBV surface antigen （HBsAg） transform during the recovery period in supplementary cards for all the reporting cases were 579 and 4 961,and the rate were 0.91% and 7.80%, respectively. 4 302 suspected acute cases were made confirmed diagnosis, and 1 197 cases （27.82%） were confirmed acute and 2 590 cases （60.20%） were confirmed chronic. Conclusion 〈br〉 Clinical doctors failed to make full use of the information of supplementary cards to make classification diagnose for hepatitis B. Suspected acute hepatitis B with anti-HBc IgM positive should be pay attention to follow up and further distinguish acute or chronic hepatitis B according to the HBsAg transform.