在以低收入和移民为主的人群中，慢性乙型肝炎感染的评估和治疗不足。

Evidence for the insufficient evaluation and undertreatment of chronic hepatitis B infection in a predominantly low-income and immigrant population.

机构信息

Harbor-UCLA Medical Center, Torrance, California, USA.

出版信息

J Gastroenterol Hepatol. 2010 Feb;25(2):369-75. doi: 10.1111/j.1440-1746.2009.06023.x. Epub 2009 Nov 19.

DOI:10.1111/j.1440-1746.2009.06023.x

PMID:19929923

Abstract

BACKGROUND AND AIM

Many physicians remain unaware of contemporary treatments for chronic hepatitis B (HBV) infection and do not treat their HBV-infected patients or refer them for treatment. The aim of the present study was to determine the rates of laboratory evaluation and treatment of HBV infection in a predominantly low-income and immigrant population.

METHODS

We identified adult patients who tested positive for hepatitis B surface antigen between 1 January 1994 and 30 April 2006. We reviewed patients' medical records to determine two outcomes: (i) receipt of pretreatment evaluation of HBV infection; and (ii) receipt of HBV treatment. We then examined clinical and demographic factors associated with these outcomes.

RESULTS

Twenty-eight percent of 1231 HBV surface antigen-positive patients received additional laboratory evaluation of their infection. In a multivariate analysis, receipt of a HBV evaluation was independently associated with (P < 0.05) female sex, longer duration of HBV infection, more visits to a gastroenterology clinic and less recent health-care contact. Data on treatment were available for 56% of patients; among these, 16% received HBV treatment. In the multivariate analysis, receipt of HBV treatment was independently associated with (P < 0.05) HIV co-infection, receipt of liver biopsy, testing for hepatitis B e antigen or HBV DNA, longer duration of HBV infection, more visits to a gastroenterology clinic and more recent health-care contact. When excluding HIV-infected patients, only 10% of patients received HBV treatment.

CONCLUSIONS

After the diagnosis of HBV infection, few patients in our population received laboratory evaluation to determine eligibility for HBV treatment. Furthermore, only a small percentage received HBV treatment. Further research needs to be done to validate these findings in other populations and understand barriers to receiving HBV treatment.

摘要

背景与目的

许多医生对慢性乙型肝炎（HBV）感染的现代治疗方法仍然一无所知，他们既不治疗自己的 HBV 感染患者，也不将其转介治疗。本研究旨在确定在以低收入和移民为主的人群中，HBV 感染的实验室评估和治疗率。

方法

我们确定了 1994 年 1 月 1 日至 2006 年 4 月 30 日期间 HBV 表面抗原检测呈阳性的成年患者。我们查阅了患者的病历，以确定两个结果：（i）是否接受了 HBV 感染的治疗前评估；（ii）是否接受了 HBV 治疗。然后，我们检查了与这些结果相关的临床和人口统计学因素。

结果

在 1231 例 HBV 表面抗原阳性患者中，有 28%的患者接受了 HBV 感染的进一步实验室评估。在多变量分析中，HBV 评估的结果与（P < 0.05）女性、HBV 感染时间较长、更多次就诊于胃肠病学诊所以及最近的医疗接触较少有关。有 56%的患者可获得治疗数据；其中，16%的患者接受了 HBV 治疗。在多变量分析中，HBV 治疗的结果与（P < 0.05）HIV 合并感染、肝活检、乙型肝炎 e 抗原或 HBV DNA 检测、HBV 感染时间较长、更多次就诊于胃肠病学诊所以及最近的医疗接触有关。排除 HIV 感染患者后，仅有 10%的患者接受了 HBV 治疗。