中国5省9家医院就诊人群中丙型肝炎患者诊疗现状研究

Current status of diagnosis and treatment of hepatitis C in hospitals

目的了解医院就诊人群中筛查出的丙型肝炎（简称＂丙肝＂）患者的诊疗状况。方法在辽宁、河南等5省9家医院中,对所有首次诊断为丙肝的患者进行横断面调查,了解其丙肝相关检测原因、肝功能等有关生化指标以及诊断和治疗等情况,并对不同级别医院的情况进行分析比较。结果共调查符合条件的丙肝患者599例,其中61.4%（368例）患者是通过被动筛查发现的,就诊者主动检测仅占17.9%（107例）;16.5%（99例）患者在诊断时已经出现了肝纤维化或肝硬化。诊断出的丙肝患者中67.9%（407例）未进行核酸检测,由于缺乏核酸检测能力,就诊于二级医院的患者均未进行核酸确诊。治疗方面,三级医院中77.6%（319例）丙肝患者未接受任何治疗,二级医院抗病毒治疗能力较差,60.1%（113例）患者接受保肝或中药治疗。在确诊丙肝病例中,接受抗病毒治疗的仅占14.6%（28/192）,其中49名急需治疗的肝纤维化或肝硬化的患者仅有2名接受了抗病毒治疗。结论中国丙肝患者主动检测意识较差,抗病毒治疗率较低,基层医院丙肝诊疗严重能力不足,应加大丙肝防治宣传力度,加强专业人员培训,进一步提升丙肝确诊能力。

Objective To understand the current status of diagnosis and treatment of hepatitis C in hospitals.Methods A cross-sectional study was conducted among the patients diagnosed with hepatitis C in 9 hospitals in Liaoning,Henan,Hunan,Guangdong and Yunnan provinces.Results Among 599 eligible respondents,61.4% were detected by passive testing such as routine screening for preoperative or antenatal procedures or for health examination.17.9% were found by active testing at the time,of which 16.5% got fibrosis or cirrhosis.Out of the 599 patients infected with HCV,67.9% were not confirmed by HCV RNA testing,because of the lack of HCV RNA testing equipment and screened by the secondary hospitals incapable of diagnosis of HCV RNA testing.77.6% patients in tertiary hospitals didn＇t receive any treatment,and secondary hospitals had inadequate ability for the antiviral treatment.60.1% patients received only liver-protective drugs or herbal treatment.192 patients had a positive HCV RNA test,of which 14.6% had antiviral treatment.Out of 49 patients with liver fibrosis or cirrhosis in urgent need of treatment,only 2 received antiviral treatment.Conclusion Most patients in hospitals are detected by routine screening,and their awareness of active testing is poor.The antiviral treatment rate is low among patients in hospitals and the diagnosis ability of primary hospital is insufficient,indicating the need to raise awareness among health care professionals and at-risk populations about hepatitis C,to strengthen the training of professionals,and to further improve the diagnostic capacity of hepatitis C.