胃肠病学家对接受免疫抑制治疗的患者进行乙型肝炎病毒筛查的比例不理想。
Gastroenterologists Have Suboptimal Hepatitis B Virus Screening Rates in Patients Receiving Immunosuppressive Therapy.
作者信息
Paul Sonali, Shuja Asim, Tam Idy, Kim Eun Min, Kang Sandra, Kapulsky Leonid, Viveiros Kathleen, Lee Hannah
机构信息
Division of Gastroenterology and Hepatology, Massachusetts General Hospital, 55 Fruit Street, Blake 4, Boston, MA, 02114, USA.
Department of Gastroenterology, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL, 23309, USA.
出版信息
Dig Dis Sci. 2016 Aug;61(8):2236-2241. doi: 10.1007/s10620-016-4118-1. Epub 2016 Mar 18.
BACKGROUND AND AIMS
Hepatitis B reactivation in patients undergoing immunosuppressive therapy can lead to liver failure and death. Prior studies have shown suboptimal hepatitis B screening rates, but few have compared screening rates across specialties or factors associated with screening.
METHODS
A retrospective study was performed using a hospital-based chemotherapy database and outpatient pharmacy records from January 1999 to December 2013. HBV screening rates prior to initiation of immunosuppression were determined. Multivariate analysis was used to determine predictors of HBV screening.
RESULTS
Of the 4008 study patients, 47 % were screened prior to receiving immunosuppressive therapy; only 48 % on rituximab and 45 % of those on anti-TNF therapy were screened. Transplant specialists screened most frequently (85 %) while gastroenterologists screened the least (34 %). Factors significantly associated with HBV screening were younger age, Asian race, use of anti-rejection therapy, and treatment by a transplant specialist (p < 0.001).
CONCLUSION
HBV screening prior to immunosuppressive therapy is suboptimal, especially among gastroenterologists. Efforts to improve screening rates in at risk populations are needed.
背景与目的
接受免疫抑制治疗的患者发生乙型肝炎再激活可导致肝衰竭和死亡。既往研究显示乙肝筛查率不理想，但很少有研究比较各专科的筛查率或与筛查相关的因素。
方法
利用1999年1月至2013年12月基于医院的化疗数据库和门诊药房记录进行一项回顾性研究。确定免疫抑制开始前的HBV筛查率。采用多变量分析确定HBV筛查的预测因素。
结果
在4008例研究患者中，47%在接受免疫抑制治疗前进行了筛查；接受利妥昔单抗治疗的患者中只有48%进行了筛查，接受抗TNF治疗的患者中这一比例为45%。移植专科医生筛查最为频繁（85%），而胃肠病学家筛查最少（34%）。与HBV筛查显著相关的因素包括年龄较小、亚洲种族、使用抗排斥治疗以及由移植专科医生治疗（p<0.001）。
结论
免疫抑制治疗前的HBV筛查不理想，尤其是在胃肠病学家中。需要努力提高高危人群的筛查率。
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