台山市2010年乙型病毒性肝炎病例报告及发病率评估分析

目的了解疾病监测信息报告管理系统中乙肝病例的报告准确性，评估台山市乙肝的实际发病水平。方法收集2010年台山市的报告发病率资料，对台山市报告的本辖区乙肝病例进行流行病学调查，采集血清后采用化学发光微粒子免疫分析法，使用雅培试剂进行HBsAg、抗-HBeIgM和抗-HAVIgM检测，根据流行病学调查结果和实验室检测结果按照卫生部发布的《乙肝诊断标准》进行诊断和复核分类，根据复核分类结果对台山市实际发病率进行估算。结果2010年台山市通过疾病监测信息报告管理系统报告乙肝病例659例，其中急性、慢性和未分类病例分别为7、327、325例，报告年发病率为31．21／10万。共报告474例本辖区病例，其中急性、慢性和未分类分别为5、193、276例，其中已检测HBsAg、抗-HBeIgM、抗-HAVIgM、HBV—DNA的病例分别占97．89％（464／474）、26．37％（125／474）、17．93％（85／474）、4．64％（22／474）。69．201（328／474）的病例有肝炎症状或体征，69．83％（331／474）的病例肝功能异常，2种合并的病例有235例（49．58％）。403例病例采血经实验室检测复核分类，急性乙肝、慢性乙肝、乙肝病毒携带者和其他病例分别为26、341、28和8例，分别占6．46％、84．62％、6．95％和1．99％，急性病例和慢性病例报告诊断和复核诊断一致的分别为2例（40．00％）和142例（89．31％）。根据复核分类结果估算2010年台山市实际发病率为3．95／10万。结论2010年台山市报告乙肝发病率可能高于实际发病水平，报告病例中实验室特异性诊断的比例较低。提示应在各级医院推广开展抗-HBeIgM等实验室特异性诊断项目，统一和修订乙肝报告标准，以保证病例报告的质量和准确性。

Accuracy of notifiable cases and estimated incidence rate of hepatitis B in Taishan City, 2010

Objective To determine the accuracy of reported hepatitis B cases of the National No- tifiable Diseases Reporting System and the estimated incidence rate of hepatitis B in Taishan City. Methods The data of reported hepatitis B cases of the National Notifiable Diseases Reporting System was collected in Taishan City in 2010. The reported local hepatitis B cases were investigated, their serum samples were collected and tested. HBsAg, anti-HBe IgM and anti-HAV IgM were tested with chemiluminescence microparticle immunoassay （CMIA） reagents produced by USA Abbott corporation. According to the diagnosis criteria of hepatitis B, the cases were reclassified by results of the investigation and tests. The incidence rate of hepatitis B was adjusted by reclassified result. Results In 2010, a total of 659 cases ware reported in Taishan City, of which, there were 7 acute cases, 327 chronic cases and 325 unclassified cases. The re- ported incidence rate of hepatitis B was 31.21 per 100 000. 474 local cases were reported, in which there were 5 acute cases, 193 chronic cases and 276 unclassified cases. The proportions of detection of HBsAg, anti-HBc IgM, anti-HAV IgM and HBV-DNA were 97.89% （464/474）, 26.37% （ 125/474）, 17.93% （85/474）, and 4.64% （22/474）, respectively. 403 cases were tested and reclassified. There were 26 a-cute cases, 341 chronic cases, 28 carriers and 8 other cases. The proportions of acute hepatitis B cases and chronic hepatitis B cases were 6.46% and 84.62% respectively after reclassification. The verification di- agnosis of 2 （40. 00% ） acute cases were consistent with the original diagnosis, and the verification diagnosis of 142 （89.3] % ） chronic cases were consistent with the original diagnosis, The estimated incidence of hepatitis B in Taishan was 3.95 per 100 000, Conclusion The reported incidence rate was higher than es- timated incidence rate of hepatitis B. The proportion of specific detection for hepatitis B markers in report eases were still low. it＇ s necessary to improve the detection ability of hepatitis B markers such as anti-HBc IgM in order to improve the accuracy of the report of hepatitis B cases. The report standard of hepatitis B cases should be revised.