≥65岁人群甲型病毒性肝炎报告高发病率调查分析  

Investigation and Analysis on High Reported Incidence Rate of Hepatitis A in ≥65 Years Old People

作　　者：张栋梁[1,2] 张国民[3] 郑徽[3] 王富珍[3] 龚晓红[3] 缪宁[3] 吴振华[3] 孙校金[3] 崔富强[3] 

机构地区：[1]宁波市疾病预防控制中心,浙江宁波315010 [2]中国疾病预防控制中心现场流行病学培训项目,北京100050 [3]中国疾病预防控制中心免疫规划中心,北京100050

出　　处：《中国疫苗和免疫》2015年第5期491-494,502,共5页Chinese Journal of Vaccines and Immunization

摘　　要：目的分析≥65岁人群甲型病毒性肝炎（甲肝）报告发病率高发原因。方法选择山西省太原市、运城市）和重庆市江津区、南川区作为调查地区,通过收集不同统计口径人口数据,分析其对甲肝报告发病率的影响;通过对2013年1~9月期间报告的≥15岁甲肝病例回顾性调查和医疗机构实验室开展甲肝病毒抗体Ig M（抗-HAV Ig M）检测,以及临床医生对甲肝诊断、报告工作的知识、态度和行为（Knowledge,Attitude and Practice,KAP）调查,评估医疗机构甲肝诊断能力。结果疾病监测信息报告管理系统中≥65岁人口数据与统计年鉴人口数据差异较大。≥65岁人群就诊机会较大,被医院筛查出抗-HAV Ig M阳性后作为甲肝病例上报的可能性较高。实验室检测结果准确性不高,责任医生诊断标准掌握不规范。结论≥65岁人群甲肝实际发病率可能被高估。≥65岁人群就诊机会大、医院抗-HAV Ig M筛查增加、检测结果不准确、执行诊断标准不规范导致甲肝病例报告数增加。Objective To analyze the reasons of high hepatitis A incidence rate in ≥65 years old people.Methods Shanxi province（ Taiyuan and Yuncheng prefectures） and Chongqing municipality（ Jiangjin and Nanchuan prefectures） were selected as the investigation regions. Demographic data from statistical yearbook and National Notifiable Disease Reporting System（ NNDRS） were collected and reviewed for their impacts on the reported incidence rate of hepatitis A. The capability of hospitals to diagnose hepatitis A was assessed through checking reported cases during January to September in 2013,reviewing hospital laboratory tests for hepatitis A virus antibody（ Anti-HAV Ig M）,and conducting a KAP survey on hepatitis A diagnoses and case reporting among clinical doctors. Results There was obvious difference in demographic data of people aged ≥65 years between statistical yearbook and NNDRS. ≥65 years old people had more opportunity to visit doctors than others; hepatitis A cases in this age group were more possible to be reported through screening for Anti-HAV Ig M. The accuracy of Anti-HAV Ig M detection in hospital laboratory was not high,and the diagnoses of hepatitis A did not meet the standard. Conclusion The incidence rate of hepatitis A in ≥65 years old people may be over-estimated. More opportunity to visit doctor for ≥65 years old people,high proportion of screening for Anti-HAV Ig M detection with low accuracy,and the ignorance of hepatitis A diagnosis standards led to the increase of reported hepatitis A cases.

关 键 词：甲型病毒性肝炎 发病率 抗-HAV IGM 

分 类 号：R511[医药卫生—内科学]