中国6省市急性乙型病毒性肝炎住院病例诊断与报告一致性分析

缪宁; 张国民; 王富珍; 郑徽; 孙校金; 马小军; 崔富强

Abstract

缪宁,张国民,王富珍,郑徽,孙校金,马小军,崔富强.中国6省市急性乙型病毒性肝炎住院病例诊断与报告一致性分析[J].Chinese journal of Epidemiology,2017,38(2):216-220

中国6省市急性乙型病毒性肝炎住院病例诊断与报告一致性分析

Consistency analysis on acute hepatitis B inpatients reported by hepatitis B surveillance pilot spots in six provinces of China

Received:August 17, 2016

DOI：10.3760/cma.j.issn.0254-6450.2017.02.016

KeyWord: 急性乙型病毒性肝炎诊断报告一致性

English Key Word: Acute hepatitis B Diagnosis Report Consistency

FundProject:国家自然科学基金（11571272）；国家科技重大专项课题（2012ZX10002001）

Author Name	Affiliation	E-mail
Miao Ning	National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Zhang Guomin	National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Wang Fuzhen	National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Zheng Hui	National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Sun Xiaojin	National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Ma Xiaojun	Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China
Cui Fuqiang	National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China	cuifuq@126.com

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Abstract:

目的了解乙型病毒性肝炎（乙肝）监测点报告的急性乙肝住院病例的基本特征，分析报告的急性乙肝病例与临床医生诊断的一致性。方法从全国法定传染病报告系统（NNDRS）中获得急性乙肝病例信息，通过查询医院信息系统（Hospital Information System）了解急性乙肝的基本情况，记录本次就诊住院的临床诊断，分析临床医生的急性乙肝诊断与NNDRS中的报告类型相一致的比例。结果本次研究对象共179例，均为2015-2016年NNDRS中报告的急性乙肝病例，其中HBsAg阳性时间6个月由阴性转为阳性者占2.79%（5/179），HBsAg阳性持续时间≥6个月者占32.40%（58/179），本次为第一次检测HBsAg或时间不详的占64.80%（116/179）；有乙肝病史的占33.52%（60/179），有甲、丙肝病史的占1.12%（2/179），无肝炎病史的占41.34%（74/179），肝炎病史不详的占24.02%（43/179）；有肝炎症状和体征的占79.89%（143/179），无肝炎症状和体征的占20.11%（36/179）。179例NNDRS报告的急性乙肝病例中，临床医生诊断为急性乙肝67例，非急性乙肝112例，急性乙肝一致率为37.43%（67/179）。不一致的病例共计112例，以诊断为慢性乙肝（49.11%，55/112）和乙肝后肝硬化（16.07%，18/112）为主。结论 NNDRS中报告的急性乙肝住院病例报告类型与临床医生的急性乙肝诊断类型一致性较差。临床医生在保证诊断准确性的前提下，应按照临床诊断分类进行网络报告，使NNDRS中乙肝的分类类型与临床医生的分类诊断相一致。

English Abstract:

Objective To understand the characteristics of acute hepatitis B inpatients reported by the hepatitis B surveillance pilot points and to estimate the consistency between the diagnosed and reported types of hepatitis B by the clinicians involved. Methods Data related to acute hepatitis B was from the NNDRS and the characteristics of acute hepatitis B were classified by querying Hospital Information System. We recorded the results based on clinical diagnosis and analyzed the consistency between the reported and diagnosed types that the clinicians made, on hepatitis B. Results A total of 179 patients were included in this study with all of them as acute hepatitis B reported through NNDRS in 2015-2016. In terms of the durations of disease, among the 179 cases who were HBsAg positive, 32.40% (58/179) of them exceeding 6 months, 2.79% (5/179) within 6 months and 64.80% (116/179) tested the first time or never. Among the 179 cases who claimed having the history of hepatitis, 33.52% (60/179) of them identified as having hepatitis B, 1.12% (2/179) were hepatitis A, C or E, 41.34% (74/179) did not have the signs on hepatitis, while the rest 24.02% (43/179) did not know the situation. Only 79.89%(143/179) of the patients showed the symptoms or signs of hepatitis, but the rest 20.11%(36/179) did not. Among the 179 reported acute hepatitis patients, 67 of them were diagnosed as acute hepatitis B while 112 cases were as non-acute hepatitis B. The consistent rate of acute hepatitis B was 37.43%(67/179). Among the 112 cases that were diagnosed as non-acute hepatitis B, proportions of chronic hepatitis B and cirrhosis were 49.11%(55/112) and 16.07%(18/112) respectively. Conclusion Consistency between the reported type of acute hepatitis B inpatients and the types diagnosed by clinicians was poor. Our results suggested that clinicians should make the accurate diagnosis at first place and then report to the Network in accordance with the clinical diagnosis classification criterfia, set by the government.

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