Department of Medicine, Medical University of South Carolina, Charleston, SC.
Department of Medicine, Medical University of South Carolina, Charleston, SC.
Am J Med. 2020 Feb;133(2):214-221.e1. doi: 10.1016/j.amjmed.2019.07.016. Epub 2019 Jul 29.
As hepatitis C virus birth cohort (1945-1965) screening in primary care improves, testing patterns in response to persistently abnormal liver tests are less well known.
This retrospective cohort study of a patient-centered medical home between 2007 and 2016 evaluates the association of abnormal liver chemistries and other clinical and demographic factors with hepatitis C antibody (HCV Ab) testing in patients with persistently abnormal liver tests. Patients with at least 2 consecutive abnormal liver tests were categorized by the clinical pattern of liver chemistry abnormality, including cholestatic, hepatocellular, and mixed patterns. The primary outcomes were: 1) completed HCV Ab tests; and 2) positive HCV Ab results for those patients tested.
Of 4512 patients with consecutive abnormal liver tests, only 730 (16%) underwent HCV Ab testing within 1 year of the second abnormality; 81/730 (11%) had HCV Ab detected. A logistic regression model revealed that mixed (odds ratio [OR] 2.20; 95% confidence interval [CI], 1.72-2.82) and hepatocellular (OR 1.43; 95% CI, 1.15-1.79) patterns of liver test abnormality, female sex, and alcohol and tobacco abuse were associated with higher odds of HCV Ab testing. Hepatocellular (OR 7.51; 95% CI, 2.18-25.94) and mixed patterns (OR 5.88; 95% CI, 1.64-21.15) of liver test abnormalities, male sex, Medicaid enrollment, and drug and tobacco abuse had higher odds of positive HCV Ab results.
There is opportunity to improve hepatitis C diagnostic testing in patients with consecutively elevated liver tests, and hepatocellular and mixed patterns of abnormality should prompt primary care providers to action.
随着丙型肝炎病毒出生队列（1945-1965 年）在初级保健中的筛查得到改善，针对持续异常肝脏检查的检测模式知之甚少。
本研究回顾性分析了 2007 年至 2016 年期间以患者为中心的医疗之家的队列，评估了异常肝脏化学物质和其他临床及人口统计学因素与持续异常肝脏检查患者丙型肝炎抗体（HCV Ab）检测之间的关联。至少有 2 次连续异常肝脏检查的患者，根据肝脏化学异常的临床模式进行分类，包括胆汁淤积、肝细胞和混合模式。主要结局是：1）完成 HCV Ab 检测；2）对接受检测的患者进行 HCV Ab 阳性检测。
在 4512 例连续异常肝脏检查的患者中，只有 730 例（16%）在第二次异常后 1 年内接受 HCV Ab 检测；730 例中有 81 例（11%）检测到 HCV Ab。Logistic 回归模型显示，混合（比值比[OR]2.20；95%置信区间[CI]1.72-2.82）和肝细胞（OR 1.43；95% CI 1.15-1.79）模式的肝试验异常、女性、酒精和烟草滥用与 HCV Ab 检测的可能性更高相关。肝细胞（OR 7.51；95% CI 2.18-25.94）和混合模式（OR 5.88；95% CI 1.64-21.15）的肝试验异常、男性、医疗补助计划（Medicaid）参保和药物及烟草滥用与 HCV Ab 阳性结果的可能性更高相关。
在连续升高的肝脏检查患者中，有机会改善丙型肝炎的诊断检测，且肝细胞和混合模式的异常应促使初级保健提供者采取行动。
