天津市医院丙型肝炎检测和诊断能力研究  

Detection of hepatitis C virus and diagnostic ability of hepatitis C infection in hospitals in Tianjin

作　　者：陈静[1] 王文权 何海艳[1] 吴伟慎[1] 赵莹[1] 张颖[1] 霍飞[1] CHEN Jing;WANG Wen-quan;HE Hai-yan;WU Wei-shen;ZHAO Ying;ZHANG Ying;HUO Fei(Tianjin Centers for Disease Control and Prevention,Tianjin 300011,China)

机构地区：[1]天津市疾病预防控制中心,天津300011 [2]天津市滨海新区大港疾病预防控制中心

出　　处：《实用预防医学》2018年第9期1071-1074,共4页Practical Preventive Medicine

摘　　要：目的了解天津市二级及以上医院开展丙型肝炎病毒抗体(抗-HCV)及核酸(HCV-RNA)检测情况,结合临床医生诊断结果评估医院诊断能力。方法 2015年从天津市全市二级及以上医院的实验室检测记录中获得2014年抗-HCV和HCV-RNA检测结果,分析二级及以上医院抗-HCV检出阳性率、HCV-RNA检测率和阳性率;采用按比例系统抽样方法对住院病例进行调查,通过查阅病案资料获得住院病例的丙型肝炎诊断情况及相关病例诊断依据,对信息不详者经征得患者同意后进行电话随访,依据《丙型病毒性肝炎诊断标准》(WS 213-2008)对病例诊断逐一进行核查和判定,分析医院诊断正确率。从2014年疾病监测信息系统中获得报告的丙型肝炎病例基本资料,将医院已诊断病例与报告病例进行信息匹配,分析医院病例报告率,计算丙型肝炎校正报告发病率。结果在2014年天津市共88家二级以上医院中,80家具备抗-HCV检测能力,占90.91%;其中22家医院具备检出或外送检测HCV-RNA能力。天津市二级以上医院丙型肝炎抗-HCV检出率为1.09%,传染病类医院抗-HCV阳性率(1.38%)要高于非传染病类医院(1.05%)(χ~2M-H Summary=401.052,P<0.001)。2014年天津市22家具备HCV-RNA检测能力医院有7 129例抗-HCV阳性者,HCVRNA检测比例为15.72%(1 121/7 129),HCV-RNA阳性率为77.88%。根据1 031例抗-HCV阳性住院患者出院登记结果显示,丙型肝炎相关疾病诊断比例为58.29%。对住院病例核查诊断后,有953例可诊断为丙型肝炎(包括临床诊断和确诊病例),已报告率为31.90%(304/953),计算2014年丙型肝炎校正报告发病率是实际报告发病率的3.13倍,丙型肝炎校正报告发病率为10.60/10万。结论 2014年天津市医院HCV-RNA实验检测项目比例较低,大部分病例未经核酸检测病毒复制情况,未能得到实验室确诊。抗-HCV阳性者住院病例漏诊和漏报比例较高,严重影响疫情报告数据的准确性,因此需Objective To investigate the ability to detect hepatitis C virus antibody（ anti-HCV） and hepatitis C virus ribonucleic acid（ HCV-RNA） in secondary and tertiary hospitals in Tianjin,and to evaluate the hospitals＇ diagnostic capability in combination with the diagnosis results of physicians. Methods The detection results of anti-HCV and HCV-RNA in 2014 were obtained from the laboratory records in above-mentioned hospitals in Tianjin in 2015,and the positive rate of anti-HCV as well as the detection rate and positive rate of HCV-RNA were analyzed. The proportional sampling strategy was used to investigate the diagnostic status of hepatitis C infection and related diagnostic evidence in inpatients by reviewing their medical records,and telephone follow-ups were performed in inpatients with unknown information after informed consents were obtained. The diagnostic results were verified for each inpatient according to the Diagnostic Criteria for Hepatitis C（ WS 213-2008） to determine the diagnostic accuracy rate. The basic data of the reported hepatitis C cases were obtained from the Disease Surveillance Information System in2014. The information of inpatients diagnosed with hepatitis C in the hospitals was matched with that of the reported cases. The reporting rate of hepatitis C cases was analyzed and the adjusted reported incidence rate of hepatitis C was calculated. Results Among the 88 tertiary hospitals in Tianjin in 2014,80（ 90.91%） hospitals had the capacity to detect anti-HCV,of which 22 hospitals had the ability to detect or send out to determine HCV-RNA. The positive rate of anti-HCV in the tertiary hospitals in Tianjin was 1.09%,and the positive rate of anti-HCV was higher in infectious disease hospitals than in non-infectious disease hospitals（1.38% vs. 1.05%,χ~2 M-H Summary= 401.052,P〈0.001）. 7,129 anti-HCV positive patients were diagnosed by the 22 hospitals with the ability to detect HCV-RNA,with the detection rate and positive rate of HCV-RNA being 15. 72%（ 1,121/7,129） and7

关 键 词：丙型病毒性肝炎 抗-HCV检出率 诊断率 校正报告发病率 

分 类 号：R512.63[医药卫生—内科学]