青海省乙型病毒性肝炎住院病例诊断报告一致性及影响因素分析  

Analysis of consistency and influencing factors in diagnosis reports of inpatients with hepatitis B in Qinghai Province

作　　者：徐瑾 阿克忠 郝增平[2] 巴文生[2] 关炳菊[2] 李晓萍 杜星星[1] 刘晓庆 马贵艳 XU Jin;A Kezhong;HAO Zengping;BA Wensheng;GUAN Bingju;LI Xiaoping;DU Xingxing;LIU Xiaoqing;MA Guiyan(Department of Public Health,Qinghai University Medical College,Xining 810016,Qinghai,China;Immunization Planning Institute,Qinghai Center for Disease Prevention and Control,Xining 810007,Qinghai,China)

机构地区：[1]青海大学医学院公共卫生系,青海西宁810016 [2]青海省疾病预防控制中心免疫规划所,青海西宁8100071

出　　处：《中国现代医生》2025年第12期14-18,共5页China Modern Doctor

基　　金：青海省卫生健康系统指导性计划项目(2023-wjzdx-37)。

摘　　要：目的对2021年青海省部分医疗机构在国家法定传染病报告信息管理系统(National Notifiable Disease Report System,NNDRS)报告的3368例乙型病毒性肝炎(简称“乙肝”)住院病例诊断信息进行复核,分析其报告一致性和影响因素。方法研究采用典型调查法,于2022年7月至2023年4月对2021年青海省32家医疗机构报告的3368例乙肝住院病例进行研究。通过复核病例诊断信息,结合Kappa一致性检验评价报告分类与复核分类的一致性,并对一致性影响因素进行单因素与多因素分析。结果急性、慢性、未分类报告分类与复核分类一致性较差(Kappa<0.40);急慢性复核一致性较差(Kappa<0.40)。影响复核一致性的主要因素有医疗机构级别、患者性别、职业、既往史及初次发病诊断单位。省级医疗机构报告的一致性较高,男性病例和牧民病例的一致性优于女性病例及其他职业。有既往史的病例复核一致性优于既往史不清楚的病例。结论2021年青海省医疗机构乙肝病例诊断报告一致性较差,存在分类不准确和重复报告的问题。建议加强医疗机构培训与监督,规范填写“附卡”信息,推广乙肝核心抗体–IgM检测,改善急慢性乙肝的分类诊断,全面提升乙肝病例诊断与报告的准确性。Objective To review the diagnostic information of 3368 viral hepatitis B inpatient cases reported by some healthcare institutions in Qinghai Province in the National Notifiable Disease Report System(NNDRS)in 2021,and to analyse the consistency of their reports and influence factor.Methods The study used the typical survey method to study 3368 hospitalized cases of hepatitis B reported by 32 medical institutions in Qinghai Province in 2021 from July 2022 to April 2023.The consistency between the reported classification and the reviewed classification was evaluated by reviewing diagnostic information of the cases,combined with the Kappa consistency test,and the consistency-influencing factors were analysed in a univariate and multivariate analysis.Results The consistency between acute,chronic,and unclassified reporting classifications and review classifications was poor(Kappa<0.40);the consistency between acute and chronic review was poor(Kappa<0.40).The main influence factor of the consistency of review included the level of medical institution,the patient’s gender,occupation,past history,and the unit of diagnosis of initial onset of illness.Provincial medical institutions reported higher consistency,and male cases and herder cases had better consistency than female cases and other occupations.Review consistency of cases with past history was better than that of cases with unclear past history.Conclusion The consistency of diagnosis and reporting of hepatitis B cases in healthcare institutions in Qinghai Province in 2021 was low,with problems of inaccurate classification and duplicate reporting.It is recommended to strengthen the training and supervision of healthcare institutions,standardise the filling of‘attached card’information,and promote the hepatitis B core antibody IgM test to improve the classification and diagnosis of acute and chronic hepatitis B,so as to comprehensively improve the accuracy of the diagnosis and reporting of hepatitis B cases.

关 键 词：乙型病毒性肝炎 诊断 复核一致性 准确性 影响因素 

分 类 号：R181.8[医药卫生—流行病学]