献血者血液乙肝病毒血清学和核酸筛查成本效益分析  

Cost-benefit analysis of hepatitis B virus serological and nucleic acid testing in blood donors

作　　者：叶贤林[1] 熊文[1] 李彤[1] 李然 黄力勤 曾劲峰[1] YEXianlin;XIONG Wen;LI Tong;LI Ran;HUANG Liqing;ZEN Jinfeng(Shenzhen Blood Center,Shenzhen 518035,China)

机构地区：[1]深圳市血液中心,广东深圳518035

出　　处：《中国输血杂志》2023年第1期56-59,共4页Chinese Journal of Blood Transfusion

基　　金：广东省自然科学基金(2021A1515010979);深圳市自然科学基金(JCYJ20190806112201646);深圳市重点医学学科基金(SZXK070)。

摘　　要：目的 为减少输血乙肝残余风险,对献血者血液乙肝病毒血清学HBsAg筛查、HBsAg+核酸单人份及HBsAg+核酸混样筛查策略的成本效益情况进行分析。方法 基于实际检测数据,根据已发表的文献确定各种参数,预测不同筛查策略下阻止窗口期感染、慢性感染及隐匿性感染的人数,计算血液乙肝病毒血清学和核酸筛查成本效益。结果 132 208份血样核酸单人份HBsAg-/HBV DNA+检出率(0.11%)高于混样检出率(0.058%)(P<0.05)。应用单人份乙肝核酸检测可阻止输血传播乙肝的病例数是混样筛查1.25倍,取得的效益亦是混样筛查1.25倍。HBsAg、HBsAg+核酸单人份及HBsAg+混样核酸3种筛查方法成本效益为1∶63.6、1∶28.6和1∶53.4。结论 血液乙肝HBsAg组合单人份核酸筛查具有最高的效益。HBV筛查应尽可能采用单人份核酸检测策略,以提高输血安全性。Objective In an effort to prevent transfusion-transmitted hepatitis B infection, universal HBsAg screening, HBsAg+MP nucleic acid test(NAT) for HBV and HBsAg + individual(ID) NAT were analyzed for cost-effectiveness. Methods On the basis of screening data and the documented parameter, the number of window period infections, chronic infections and occult infections was constructed, and cost-benefit analysis was conducted. Results Of 132 208 donations, the yield rate of ID NAT for HBsAg-/DNA+(0.11%) was significantly higher than HBsAg+ MP NAT(0.058%). Furthermore, the predicted preventing transfusion transmitted HBV cases by ID NAT is 1.25 times as that by MP-6 NAT, so did the benefits. The cost-benefit of the three screening models were 1∶63.6、1∶28.6 and 1∶53.4. Conclusion Universal HBsAg in combination with ID HBV NAT screening was the most effective among all screening strategy. It is necessary to applied HBsAg and ID HBV NAT screening for the safety of blood transfusion.

关 键 词：乙肝病毒 乙肝表面抗原 献血者 核酸检测 单人份 混样 

分 类 号：R457.1[医药卫生—治疗学] R446[医药卫生—临床医学] R373.2