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目的分析福建省泉州市南安市、晋江市及安溪县3个县(市)2011、2013年乙型病毒性肝炎(乙肝)监测工作前后乙肝病例诊断以及报告质量情况,为更好地规范乙肝诊断和报告,了解急性乙肝发病情况,为乙肝防控提供参考依据。方法采用分层系统随机抽样方法,抽取南安市、晋江市和安溪县9家医疗机构2011年以及2013年乙肝报告病例,通过查阅病历和实验室检测结果对照乙肝诊断标准进行报告诊断核实调查。并在每个医院选取一定数量的临床医生,通过问卷和访谈调查,了解其对乙肝病例诊断、报告相关知识的认知情况。结果 2011年乙肝病例诊断报告准确率为93.4%(255/273),误报率6.6%(18/273)。2013年诊断报告准确率为96.7%(265/274),误报率为3.3%(9/274)。2011年乙肝分类诊断准确率为78.1%,2013年为91.8%。调查64名临床医生,14.1%的医生认为乙肝病例要反复上报;3.1%的医生认为乙肝病毒携带者也需要上报;3个县(市)2013年乙肝报告发病率为67.5/10万,较2011年下降了5.9%,其中急性乙肝下降了82.9%,未分类病例减少85.8%。结论 3个试点县(市)开展乙肝监测工作后乙肝诊断报告及分类诊断正确率有明显提高,急性乙肝报告发病率明显下降。乙肝报告诊断仍有重报、错报、诊断不清现象,需继续加强对医疗机构的培训和督导。
Objective To analyze the diagnosis and quality of hepatitis B cases before and after the surveillance of hepatitis B virus in 2011 and 2013 in three counties (cities) in Nanan City, Jinjiang City and Anxi County, Quanzhou, Fujian Province. In order to better regulate the diagnosis of hepatitis B, And reports to understand the incidence of acute hepatitis B, hepatitis B prevention and control provide a reference. Methods A stratified systematic random sampling method was used to extract reported cases of hepatitis B in 2011 and 2013 from 9 medical institutions in Nanan City, Jinjiang City and Anxi County. The diagnosis of hepatitis B was diagnosed and verified through consulting the medical records and laboratory test results. And select a certain number of clinicians in each hospital, through questionnaires and interviews survey to understand the diagnosis of hepatitis B cases, the knowledge of the report of the cognitive situation. Results The diagnostic accuracy rate of hepatitis B cases in 2011 was 93.4% (255/273) and the false positive rate was 6.6% (18/273). The diagnostic accuracy of 2013 was 96.7% (265/274) and the false positive rate was 3.3% (9/274). 2011 diagnosis of hepatitis B accuracy was 78.1% in 2013 was 91.8%. Survey of 64 clinicians, 14.1% of doctors believe that hepatitis B cases to be repeatedly reported; 3.1% of doctors believe that hepatitis B virus carriers also need to report; 3 counties (municipalities) in 2013 the incidence of hepatitis B reported 67.5 / 100,000, compared with 2011 The annual decline of 5.9%, of which acute hepatitis B decreased 82.9%, unclassified cases decreased 85.8%. Conclusion The correctness of diagnosis and classification of hepatitis B after hepatitis B surveillance work in 3 pilot counties (cities) was significantly improved, and the incidence of acute hepatitis B was significantly decreased. Hepatitis B report diagnosis is still heavy, mispronounced, unclear diagnosis, the need to continue to strengthen the training and supervision of medical institutions.