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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 causes of high incidence of hepatitis A (A) patients aged 65 and older. Methods We selected Taiyuan City, Yuncheng City of Shanxi Province and Jiangjin District and Nanchuan District of Chongqing Municipality as survey areas to analyze the impact of the data on the incidence of hepatitis A by collecting data of different statistical population. Through the analysis of the report from January to September 2013, Hepatitis A Retrospective Survey of ≥15 Years and Hepatitis A Antibody IgM (Anti-HAV Ig M) Tests in Medical Institutions and Knowledge, Attitude and Practice of Clinicians for Diagnosis and Reporting of Hepatitis A , KAP) survey to assess the diagnosis of hepatitis A in medical institutions. Results The data of population ≥65 years old in the disease monitoring information report management system and the data of the statistical yearbook differed significantly. People 65 years of age or older have a greater chance of being referred to hospital and are more likely to be reported as hepatitis A after being screened by the hospital for anti-HAV Ig M positive. The accuracy of laboratory test results is not high, the responsibility of doctors to master the diagnostic criteria are not standardized. Conclusion The actual incidence of hepatitis A in people over 65 years may be overestimated. Patients with a history of ≥65 years of age have a large chance of being hospitalized, screening of anti-HAV Ig M in hospitals increases, the test results are inaccurate, and the number of hepatitis A cases reported is increased due to the non-standard diagnostic criteria.