云南省医务人员对结核患者肝炎病毒感染筛查认知的横断面研究

目的调查云南省从事结核病诊疗的医务人员对结核病患者筛查和监测乙型/丙型肝炎病毒(HBV/HCV)感染的认知。方法调查对象为云南省全部16个州、市综合医院中从事结核病诊疗的医务人员,通过问卷调查方式收集他们对抗结核治疗或应用糖皮质激素前对肝炎病毒筛查和管理的决定。结果共发出问卷1000份,回收问卷942份,剔除无效问卷52份。合格的890份问卷分别来自21家三级综合医院和64家二级综合医院。在抗结核治疗前,医务人员对抗-HCV筛查的比例(48.8%,434/890)低于对乙型肝炎病毒表面抗原(HBs Ag)筛查的比例(70.7%、629/890,χ^2=88.805、P<0.001)。在应用糖皮质激素前,对抗-HCV筛查的比例(72.1%,642/890)也低于对HBsAg筛查的比例(75.6%,673/890),但差异无统计学意义(χ^2=2.794、P=0.094)。Logistic回归多变量分析提示:使用糖皮质激素前,医务人员所在的科室类别和职称是筛查抗HCV的独立的影响因素,其中来自感染科(OR=1.834、95%CI:1.342~2.505、P=0.001)及高级职称(OR=1.745、95%CI:1.115~2.731、P=0.015)医务人员的诊疗认知优于非感染科及非高级职称医务人员,差异均有统计学意义;所在医院等级、科室类别和职称是筛查HBsAg的影响因素,其中来自三级医院(OR=1.735、95%CI:1.233~2.441、P=0.002)、感染科(OR=1.567、95%CI:1.133~2.167、P=0.007)及高级职称(OR=1.786、95%CI:1.104~2.888、P=0.018)医务人员的诊疗认知优于二级医院、非感染科及非高级职称医务人员,差异均有统计学意义。使用糖皮质激素时,医院等级和科室类别是医务人员对结核合并HCV感染者监测HCV RNA的影响因素,其中三级医院(OR=1.898、95%CI:1.285~2.802、P=0.001)、感染科(OR=2.039、95%CI:1.391~2.988、P<0.001)医务人员的诊疗认知优于二级医院及非感染科医务人员,差异均有统计学意义。医院等级、科室类别和职称为医务人员对结核合并HBV感染监测HBV DNA的影响因素,其中三级医院(OR=2.019、95%CI:1.385~2.943、P<0.001)、感染科(OR=2.269、95%CI:1.573~3.275、P<0.001)和高级职称(OR=2.435、95%CI:1.373~4.320、P=0.002)医务人员的诊疗认知优于二级医院、非感染科和非高级职称医务人员,差异均有统计学意义。结论从事结核病诊疗的医务人员对于结核病患者筛查和监测肝炎病毒认知差异较大,加强指导和培训将有益于提升医务人员对结核病合并肝炎病毒感染的认知,以降低肝功能损伤的发生。

Cross-sectional study on knowledge of medical workers towards hepatitis virus screening and monitoring of tuberculosis patients in Yunnan province

Objective To investigate the knowledge of medical workers towards the screening and management of hepatitis B/C virus(HBV/HCV)among patients with tuberculosis.Methods A questionnaire survey was conducted in tertiary and secondary comprehensive hospitals of 16 autonomous prefectures and cities in Yunnan Province in 2018.The participants should be involved in the diagnosis and treatment of tuberculosis,and their decisions on screening and monitoring serum biomarkers of HBV and HCV before antituberculosis and glucocorticoid treatment were collected.Results A total of 1000 questionnaires were sent out,and 942 questionnaires were collected.After 52 invalid questionnaires were excluded,890 questionnaires were finally valid,which came from 21 tertiary hospitals and 64 secondary hospitals.The proportion of medical workers deciding to screen anti-HCV(48.8%,434/890)was significantly lower than that of deciding to screen HBs Ag(hepatitis B surface antigen)(70.7%,629/890;χ^2=88.805,P<0.001)before anti-tuberculosis treatment.The proportion of medical workers who decided to screen anti-HCV(72.1%,642/890)was also lower than that for HBsAg screening(75.6%,673/890)before glucocorticoid treatment,although the overall difference was not significant(χ^2=2.794,P=0.094).Binary logistic regression multivariate analysis showed that the department category and professional title were independent predictors for medical workers screening antiHCV before glucocorticoid treatment.The knowledge of decision on screening anti-HCV were relatively higher among the medical workers in the department of infectious diseases(OR=1.834,95%CI:1.342-2.505,P=0.001),the senior title(OR=1.745,95%CI:1.115-2.731,P=0.015).Hospital level,department category and professional title were independent predictors for medical workers screening HBsAg before glucocorticoid treatment.The knowledge of decision on screening HBsAg were relatively higher among the medical workers in tertiary hospital(OR=1.735,95%CI:1.223-2.441,P=0.002),in the department of infectious diseases(OR=1.567,95%CI:1.133-2.167,P=0.007)and the senior title(OR=1.786,95%CI:1.104-2.888,P=0.018).During glucocorticoid treatment,both hospital level and department category were independent predictors for medical workers to monitor HCV RNA.The knowledge of decision on monitoring HCV RNA were relatively higher among the medical workers in tertiary hospital(OR=1.898,95%CI:1.285-2.802,P=0.001),in the department of infectious diseases(OR=2.039,95%CI:1.391-2.988,P<0.001)than those of staff in secondary hospital and not department of infectious diseases and hospital level,department category and professional title were independent predictors for medical workers to monitor HBV DNA.The knowledge of decision on monitoring HBV DNA were relatively higher among the medical workers in tertiary hospital(OR=2.019,95%CI:1.385-2.943,P<0.001),in the department of infectious diseases(OR=2.269,95%CI:1.573-3.275,P<0.001)and the senior title(OR=2.435,95%CI:1.373-4.320,P=0.002).Conclusions Medical workers might have great gaps in their knowledge towards the screening and management of hepatitis virus in tuberculosis patients.Increased training on viral hepatitis to medical worker will benefit prevention of liver injury in tuberculosis patients.