病毒性肝炎临床流行病学研究
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摘要
第一部分病毒性肝炎病原学分析
目的:通过系列血清检测,对临床病毒性肝炎作病原学分析。
方法:收集急性病毒性肝炎住院病例病案,采集病例系列血清及粪便标本,采用ELISA方法检测病毒性肝炎血清标志物,RT-nPCR方法行粪便戊型肝炎病毒核酸检测。
结果:各型肝炎中临床最易在急性乙型肝炎和慢性乙型肝炎急性发作之间造成误诊。
结论:系列血清检测可提高临床病毒性肝炎诊断的准确性。
第二部分急性病毒性肝炎症状特征比较
目的:比较各型急性病毒性肝炎不同的症状特征。
方法:收集急性病毒性肝炎住院病例病案资料,运用统计方法比较各型肝炎症状特征指标。
结果:男性青壮年是乙肝的高发人群,甲肝(39.70±15.86)和乙肝(39.84±11.69)较戊肝发病年龄轻(49.00±14.52);甲肝患者发热的比例(80%)最高;乙肝患者血清ALT(1391.47±566.17U/L)、AST(832.43±786.52U/L)水平和胆红素异常率(100%)在各型肝炎中最高;而戊肝的前白蛋白(0.09±0.06g/L)、白蛋白(38.81±4.10g/L)、C3(0.80±0.41g/L)、C4(0.18±0.17g/L)、CHE(5920.42±1403.73U/L)等指标在各型肝炎中均最低,而其胆汁酸TBA(215.95±155.24μmol/L)在各型肝炎中最高。
结论:戊肝的肝损伤相对其他几型肝炎更严重。
第三部分2005年闵行区急性病毒性肝炎网络直报工作质量分析
目的:分析2005年闵行区急性病毒性肝炎网络直报工作质量。
方法:收集2005年1月～2005年12月,中国疾病预防控制信息系统中上海市闵行区急性病毒性肝炎报告资料、复旦大学附属第五人民医院传染科病毒性肝炎住院病例病案信息,运用质量分析指标(报告率、及时率、完整率、更正率、正确率)评估报告质量。
结果:2005年闵行区急性病毒性肝炎网络报告率100%;报告及时率92.79%,其中二级医院及时率较社区医院及时率高:完整率以病例工作单位信息缺失较严重,另有部分病例联系电话缺失;住院病例医院及时更正率76.87%;报告正确率65.5%。
结论:2005年闵行区急性病毒性肝炎网络报告质量较好,其中突出的问题是因临床诊断的错误而造成报告错误。
PartⅠ:Analyze the etiology of viral hepatitis
Objective:Analyze the etiology of viral hepatitis based on serial serum detection.
Methods:The medical record,serial sera and feces of hospitalized acute viral hepatitis in this hospital were collected.Serum hepatitis markers and hepatitis E viral nucleic acid in patients' feces were detected respectively by ELISA and / or RT-nPCR.
Results:It most easily to misdiagnosis between acute hepatitis B and chronic hepatitis B acute episode in clinic.
Conclusions:The diagnosis to viral hepatitis may be more exact in clinic by serial serum test.
PartⅡ:Comparison of clinical features among different type of acute hepatitis
Objective:To compare the differences in clinical features among different type of acute hepatitis.
Methods:The medical records of the acute hepatitis cases in hospital were collected to analyze the epidemiology and clinical features of different type of acute hepatitis.
Results:In comparison to hepatitis A,and hepatitis B,patients with hepatitis E were older(39.70±15.86,39.84±11.69 vs 49.00±14.52 years,P＜0.01),and compare to other hepatitis,patients with hepatitis A were most likely to have a temperature(P＜0.01).In laboratory data,hepatitis B patients had highest serum levels of lanine aminotransferase(1391.47±566.17U/L),and aspartate aminotransferase(832.43±786.52 U/L),and most likely abnormal in albumin(100%),hepatitis E patients had highest serum levels of prealbumin (0.09±0.06g/L),and albumin(38.81±4.10g/L),C3(0.80±0.41g/L.),C4(0.18±0.17g/L) and CHE(5920.42±1403.73U/L)and lowest serum levels of total bile acid(215.95±155.24μmol/L).
Conclusions:In comparison to other hepatitis,patients with hepatitis E had more serious hepatic injury.
PartⅢ:Analysis of the quality of acute hepatitis net report in Minhang district in Shanghai in 2005.
Objective:To analyze the quality of acute hepatitis net report in Minhang district in Shanghai in 2005.
Methods:The information of acute hepatitis reports on China information system for diseases control and prevention of Minhang district in Shanghai from January to December in 2005 and the the medical records of the acute hepatitis cases in Shanghai 5th People's Hospital,Fudan University were collected to analyze the report quality by some indexes such as report ratio,in time ratio,completion ratio,correction ratio,exact reportion ratio.
Results:The report ratio of acute hepatitis net report in Minhang district in Shanghai in 2005 was 100%,and the in time ratio was 92.79.The in time ratio of the second order hospitals were higher than of the community hospitals.The information of the patients' unit of work was seriously absent,while there was partly patients' telephone number absent.The in time correction ratio of hospitalize patients was 76.87%,while the exact reportion ratio was 65.5%.
Conclusions:The quality of acute hepatitis net report in Minhang district in Shanghai in 2005 was good,and the exerted problem was the error reportion caused by error diagnosis.
目的:通过系列血清检测,对临床病毒性肝炎作病原学分析。
方法:收集急性病毒性肝炎住院病例病案,采集病例系列血清及粪便标本,采用ELISA方法检测病毒性肝炎血清标志物,RT-nPCR方法行粪便戊型肝炎病毒核酸检测。
结果:各型肝炎中临床最易在急性乙型肝炎和慢性乙型肝炎急性发作之间造成误诊。
结论:系列血清检测可提高临床病毒性肝炎诊断的准确性。
第二部分急性病毒性肝炎症状特征比较
目的:比较各型急性病毒性肝炎不同的症状特征。
方法:收集急性病毒性肝炎住院病例病案资料,运用统计方法比较各型肝炎症状特征指标。
结果:男性青壮年是乙肝的高发人群,甲肝(39.70±15.86)和乙肝(39.84±11.69)较戊肝发病年龄轻(49.00±14.52);甲肝患者发热的比例(80%)最高;乙肝患者血清ALT(1391.47±566.17U/L)、AST(832.43±786.52U/L)水平和胆红素异常率(100%)在各型肝炎中最高;而戊肝的前白蛋白(0.09±0.06g/L)、白蛋白(38.81±4.10g/L)、C3(0.80±0.41g/L)、C4(0.18±0.17g/L)、CHE(5920.42±1403.73U/L)等指标在各型肝炎中均最低,而其胆汁酸TBA(215.95±155.24μmol/L)在各型肝炎中最高。
结论:戊肝的肝损伤相对其他几型肝炎更严重。
第三部分2005年闵行区急性病毒性肝炎网络直报工作质量分析
目的:分析2005年闵行区急性病毒性肝炎网络直报工作质量。
方法:收集2005年1月～2005年12月,中国疾病预防控制信息系统中上海市闵行区急性病毒性肝炎报告资料、复旦大学附属第五人民医院传染科病毒性肝炎住院病例病案信息,运用质量分析指标(报告率、及时率、完整率、更正率、正确率)评估报告质量。
结果:2005年闵行区急性病毒性肝炎网络报告率100%;报告及时率92.79%,其中二级医院及时率较社区医院及时率高:完整率以病例工作单位信息缺失较严重,另有部分病例联系电话缺失;住院病例医院及时更正率76.87%;报告正确率65.5%。
结论:2005年闵行区急性病毒性肝炎网络报告质量较好,其中突出的问题是因临床诊断的错误而造成报告错误。
PartⅠ:Analyze the etiology of viral hepatitis
Objective:Analyze the etiology of viral hepatitis based on serial serum detection.
Methods:The medical record,serial sera and feces of hospitalized acute viral hepatitis in this hospital were collected.Serum hepatitis markers and hepatitis E viral nucleic acid in patients' feces were detected respectively by ELISA and / or RT-nPCR.
Results:It most easily to misdiagnosis between acute hepatitis B and chronic hepatitis B acute episode in clinic.
Conclusions:The diagnosis to viral hepatitis may be more exact in clinic by serial serum test.
PartⅡ:Comparison of clinical features among different type of acute hepatitis
Objective:To compare the differences in clinical features among different type of acute hepatitis.
Methods:The medical records of the acute hepatitis cases in hospital were collected to analyze the epidemiology and clinical features of different type of acute hepatitis.
Results:In comparison to hepatitis A,and hepatitis B,patients with hepatitis E were older(39.70±15.86,39.84±11.69 vs 49.00±14.52 years,P＜0.01),and compare to other hepatitis,patients with hepatitis A were most likely to have a temperature(P＜0.01).In laboratory data,hepatitis B patients had highest serum levels of lanine aminotransferase(1391.47±566.17U/L),and aspartate aminotransferase(832.43±786.52 U/L),and most likely abnormal in albumin(100%),hepatitis E patients had highest serum levels of prealbumin (0.09±0.06g/L),and albumin(38.81±4.10g/L),C3(0.80±0.41g/L.),C4(0.18±0.17g/L) and CHE(5920.42±1403.73U/L)and lowest serum levels of total bile acid(215.95±155.24μmol/L).
Conclusions:In comparison to other hepatitis,patients with hepatitis E had more serious hepatic injury.
PartⅢ:Analysis of the quality of acute hepatitis net report in Minhang district in Shanghai in 2005.
Objective:To analyze the quality of acute hepatitis net report in Minhang district in Shanghai in 2005.
Methods:The information of acute hepatitis reports on China information system for diseases control and prevention of Minhang district in Shanghai from January to December in 2005 and the the medical records of the acute hepatitis cases in Shanghai 5th People's Hospital,Fudan University were collected to analyze the report quality by some indexes such as report ratio,in time ratio,completion ratio,correction ratio,exact reportion ratio.
Results:The report ratio of acute hepatitis net report in Minhang district in Shanghai in 2005 was 100%,and the in time ratio was 92.79.The in time ratio of the second order hospitals were higher than of the community hospitals.The information of the patients' unit of work was seriously absent,while there was partly patients' telephone number absent.The in time correction ratio of hospitalize patients was 76.87%,while the exact reportion ratio was 65.5%.
Conclusions:The quality of acute hepatitis net report in Minhang district in Shanghai in 2005 was good,and the exerted problem was the error reportion caused by error diagnosis.
引文
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7.曹春艳.乙型病毒性肝炎病人误诊率调查[J].中国公共卫生,2005,21(7):884.
8.慢性乙型肝炎防治指南(节选).中华预防医学杂志.2006,2:136-140.
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2.郑英杰,张军,高眉扬.上海市90年代早期病毒性肝炎的病原学特征.中华传染病学杂志,2005(6):p.355-7.
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2.卫生部公布2007年全国法定报告传染病疫情[R].中华人民共和国卫生部公报,2008,4.64.
3.中华医学会传染病与寄生虫病学分会、肝病学分会联合修订,2000年9月西安.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):56-62.
4.Riddell MA,Li F,and Anderson DA.Identification of immunodominant and conformational epitopes in the capsid protein of hepatitis E virus by using monoclonal antibodies[J].J Virol.2000,17:8011-8017.
5.郑英杰,姜庆五,张军,等.三种戊型肝炎诊断试剂可靠性的研究[J].中华肝脏病杂志.2004,1:17-18.
6.卢永,崔富强,王晓军,等.中国八省市各级医疗机构确诊急性乙型肝炎实验室检测能力调查[J].中华流行病学杂志.2006,9:802.
7.曹春艳.乙型病毒性肝炎病人误诊率调查[J].中国公共卫生,2005,21(7):884.
8.慢性乙型肝炎防治指南(节选).中华预防医学杂志.2006,2:136-140.
1.卫生部公布全国人群乙肝血清流行病学调查结果 我国乙肝免疫预防工作取得显著成绩.中华人民共和国卫生部,2008,4.
2.郑英杰,张军,高眉扬.上海市90年代早期病毒性肝炎的病原学特征.中华传染病学杂志,2005(6):p.355-7.
3.Chau TN,Lai ST,mse C,et al.Epidemiology and clinical features of sporadic hepatitis E as compared with hepatitis A[J].Am J Gastroenterol.,2006 101(2):292-296.
4.Sainokami S,Abe K,Kumagai I,et al.Epidemiological and clinical study of sporadic acute hepatitis E caused by indigenous strains of hepatitis E virus in Japan compared with acute hepatitis A[J].J Gastroenterol,2004, 39(7):640-648.
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