中国规范化乙型肝炎病例监测项目内江结果分析

Analysis of the results of China 's standardized hepatitis B monitoring program in Neijiang

目的通过在内江地区试行新的乙型肝炎病例诊断、报告流程,探索新的诊断报告流程在实施过程中的可行性及存在的问题,提高地区乙型肝炎分类诊断的准确性。方法临床医师在研究1年时间里接诊患者时:(1)详细准确地了解乙型肝炎病例HBs Ag既往阳性情况(何时首次发现HBs Ag阳性)。(2)按照实施方案,对所有就诊的乙型肝炎患者,在不影响常规检测的前提下,增加抗-HBc Ig M 1∶1 000稀释检测(项目执行期间该指标为免费检测)。(3)临床医师在收到实验室的检测结果后,完成相关病毒性肝炎病例诊断后填写传染病报告卡"附卡"中。医院检测的标本备份保存,每半年转运至四川省疾控中心复核,并报国家疾控中心。项目工作实施结束后(1年时间),将医院报告的新发乙型肝炎病例与近3年同期报告的新发乙型肝炎病例情况进行比较,得出不同检测方法、诊断方法、报告流程的差异性。结果乙型肝炎病毒感染者上报例数:2011年435例、2012年395例、2013年257例、2014年76例。2014年较2013年乙型肝炎上报下降70.43%,差异有统计学意义(P<0.05)。结论本次项目的实施对项目医院乙型肝炎病例分类诊断的准确性有了显著性提高,抗-HBc Ig M(1∶1 000稀释)检测的应用有一定临床价值,加大抗-HBc Ig M(1∶1 000稀释)检测范围能更准确地掌握本地区乃至全国急性乙型肝炎、慢性乙型肝炎的实际情况,更客观地反映乙型肝炎疫苗的预防效果。

Objective To improve the accuracy in classifying diagnosis of hepatitis B through the feasibility and problems existed in the process of implementation of trying out new diagnosis,reporting process and exploring new diagnosis report flow of hepatitis B cases in Neijiang city. Methods Clinicians spent one year time during the process of receiving the patients for treatment：（1） detailed and accurate understanding of past HBs Ag positive of hepatitis B patients（when the HBs Ag positive first found）;（2） in accordance with the implementation of the program,for all medical cases of hepatitis B disease,under the premise of not influencing the routine detection,add anti-HBc Ig M 1∶ 1 000 dilution detection（ free testing of the index during project execution）;（ 3） clinicians filled out report card ＂Supplementary Card＂of the infectious disease after receiving the laboratory test results and finishing relevant diagnosis of virus hepatitis. The hospital testing specimens were backup and storage,transportation to the Sichuan provincial CDC every 6months for reviewing,and then reported to the National Center for Disease Control and Prevention. After the end of the implementation of the project work（ one year）,clinicians compared new cases of hepatitis B with that of nearly the past3 years at the same time and then drew the different detection methods,diagnostic methods and difference of report flow.Results There were 435 cases in 2011,395 cases in 2012,257 cases in 2013 and 76 cases in 2014. Compared with the 2013 report of hepatitis B,that of 2014 was decrease by 70. 43%,there had a significant difference（ P〈0. 05）.Conclusion This implementation of the project has noticeably improved the accuracy of classifying diagnosis of the hospital project in the aspect of hepatitis B diagnosis. The application of anti-HBc Ig M（ dilution of 1∶ 1 000） detection has clinical value. The increase in anti-Hbc Ig M range can more accurately grasp the real situation of acute hepatitis B,chronic hepatitis B in the local area and all over the country,and more objectively reflect preventive effect of hepatitis B vaccine.