Nguyen Minhhuyen T, Herrine Steven K, Laine Christine A, Ruth Karen, Weinberg David S
Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Arch Intern Med. 2005 Sep 26;165(17):2013-8. doi: 10.1001/archinte.165.17.2013.
Because of the low prevalence of hepatitis C virus (HCV) infection in the general population, mass screening would be expensive and of low yield. Some researchers advocate targeted screening of persons at elevated HCV risk.
This cross-sectional study aimed to develop a patient-administered tool to assess HCV infection risk. Two hundred seven patients with unknown HCV status from a general medicine practice and 222 HCV-positive patients from a hepatology practice completed a 72-item survey about demographic, social, and clinical risk factors for HCV infection. General medicine patients also underwent HCV serologic testing.
Three (1.5%) of 207 general medicine patients had positive HCV antibody test results. These patients plus the 222 hepatology patients were significantly more likely than HCV-negative patients to report an array of factors. In a multivariable model, 7 factors remained significantly associated with HCV infection: sex with a prostitute or an injecting drug user, exposure to blood products, refusal as a blood donor or as a life insurance applicant, witnessing illicit drug use, and self-reported HBV infection. A simplified model that assigned 1 point for each factor present predicted HCV infection as well as a weighted model (based on chi(2) testing and receiver operating characteristic curve comparison). In a population with a 2% prevalence of HCV infection, people who identified 2 risk factors had a 10% chance of HCV infection, whereas those with 4 or more risk factors had a 50% chance.
A self-administered 72-item questionnaire can stratify patients into HCV risk groups. If validated in other primary care populations, this instrument could help target HCV screening.
由于丙型肝炎病毒（HCV）在普通人群中的感染率较低，大规模筛查成本高昂且收益较低。一些研究人员主张对HCV感染风险较高的人群进行有针对性的筛查。
这项横断面研究旨在开发一种患者自行填写的工具，以评估HCV感染风险。来自普通内科诊所的207名HCV感染状况不明的患者以及来自肝病科诊所的222名HCV阳性患者完成了一项关于HCV感染的人口统计学、社会和临床风险因素的72项调查问卷。普通内科患者还接受了HCV血清学检测。
207名普通内科患者中有3名（1.5%）HCV抗体检测结果呈阳性。与HCV阴性患者相比，这些患者以及222名肝病科患者报告一系列因素的可能性显著更高。在多变量模型中，7个因素仍与HCV感染显著相关：与妓女或注射吸毒者发生性行为、接触血液制品、被拒绝作为献血者或人寿保险申请人、目睹非法吸毒以及自我报告的HBV感染。一个为每个存在的因素赋予1分的简化模型对HCV感染的预测效果与加权模型（基于卡方检验和受试者工作特征曲线比较）相同。在HCV感染率为2%的人群中，识别出2个风险因素的人HCV感染几率为10%，而有4个或更多风险因素的人感染几率为50%。
一份72项的自行填写问卷可将患者分为HCV风险组。如果在其他初级保健人群中得到验证，该工具可有助于确定HCV筛查对象。
