周冰，　彭素标，　张卫



北京市门头沟区医疗机构病毒性肝炎报告现状调查及对策探讨

周冰1，彭素标2，张卫3

【摘要】目的调查北京市门头沟区病毒性肝炎高发原因，以便有针对性地提出防控对策。方法使用描述流行病学方法分析门头沟区病毒性肝炎报卡的特点，同时通过摘抄病例、调查走访和流行病学访视等形式调查病毒性肝炎诊断报告的依据，对照病毒性肝炎行业诊断标准WS-2008判断病例报告是否准确。结果门头沟区病毒性肝炎报告呈现报卡医院相对集中、报卡科室和报卡医生相对分散的特点。走访医院发现，大量临床医生对诊断标准掌握不清、诊断标准掌握普遍宽松，导致大量不符合诊断标准的病例被上报，诊断准确率不足50%。结论北京市门头沟区病毒性肝炎报告发病率较高主要与大量未达到诊断标准的病例误报有关。为提高病毒性肝炎报告的准确率，应采取加强医疗机构的诊断报告水平、成立规范化的肝炎门诊和医疗机构应建立病毒性肝炎报卡自查核实制度等综合措施。

【关键词】病毒性肝炎;诊断;调查研究

The Report Status of Viral Hepatitis of Medical Institutions and the Related Countermeasures in Mentougou District of Beijing City

ZHOU Bing, PENG Subiao, ZHANG Wei.MentougouCenterforDiseaseControlandPrevention,Beijing, 102300,China

【Abstract】ObjectivesTo investigate the causes of the high incidence of viral hepatitis in Mentougou district, and to provide targeted measures for prevention and control.MethodsDescription epidemiological methods were used to analyze the viral hepatitis report card in Mentougou, and through excerpting medical records and investigation to estimate whether the viral hepatitis diagnosis was reasonable based on viral hepatitis diagnosis standard WS-2008.ResultsViral hepatitis report cards were relatively concentrated in some hospitals in Mentougou district, but the doctors who reported cards were distributed in various departments. A large number of clinical doctors didn’t master the diagnosis standard exactly, resulting in a large number of cases were reported by fault diagnosis. The correct diagnosis was less than 50%.Conclusions The high incidence of viral hepatitis in Mentougou was caused mainly by a large number of cases reported by false diagnosis. Measures should be taken to improve the accuracy of viral hepatitis report, such as strengthening the diagnosis accuracy in the hospital, establishing the standardized hepatitis clinic and establishing a self verification system of viral hepatitis in medical organizations, etc.

【Key words】 Viral hepatitis;Diagnosis;Investigation and study

病毒性肝炎是法定乙类传染病，乙型、丙型和丁型肝炎患者可演变成慢性肝炎，并可发展为肝硬化和原发性肝细胞癌，对人民健康造成很大危害[1-3]。近年来，门头沟区病毒性肝炎报告发病率处于北京市较高水平，为了解门头沟区病毒性肝炎高发原因，为制定病毒性肝炎防控策略提供依据，本研究于2013年7-8月，对北京市门头沟区病毒型肝炎的报告现状进行了调查，以探讨其病毒性肝炎高发原因，便于提出针对性的防控对策。……