慢性乙肝患者的不理想的治疗率

StephenW

BMJ Open Gastro 2015; 2:e000060 doi:10.1136/bmjgast-2015-000060
Long-term follow-up and suboptimal treatment rates of treatment-eligible chronic hepatitis B patients in diverse practice settings: a gap in linkage to care
Vinh D Vu1, Ailinh Do1, Nghia H Nguyen2, Lily H Kim1, Huy N Trinh3, Huy A Nguyen3, Khanh K Nguyen3, My Nguyen3, Andrew Huynh3, Mindie H Nguyen1,
Author Affiliations
1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
2School of Medicine, University of California, San Diego, California, USA
3San Jose Gastroenterology, San Jose, California, USA
Received:
13 August 2015
Accepted:
30 September 2015
Published Online:
21 October 2015
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

   
Abstract
Background and aims

Despite available effective therapies, only a minority of patients with chronic hepatitis B (CHB) receive treatment. Our goal is to study treatment rates and time to treatment initiation in patients who meet treatment criteria on long-term follow-up.
Methods

We performed a retrospective cohort study of 608 consecutive treatment-eligible patients with CHB (by 2008 US Panel or 2009 American Association for the Study of Liver Disease (AASLD) criteria) at a US community gastroenterology clinic and a university liver clinic between 2007 and 2011. Patients were observed until they started treatment or last follow-up if untreated.
Results

Mean age was 44 and most were Asian (96%) with community patients being younger and having lower alanine aminotransferase (ALT) levels. A total of 62% started treatment, and 38% remained untreated after median follow-up of 17 months (IQR=1–40 months). Overall, treatment rate was significantly higher at university liver clinic than in the community (66.7% vs 59.9%, p=0.01). In multivariate analysis, older age (HR 1.02, p=0.002), male gender (HR 1.37, p=0.02), and baseline ALT >45 U/L for males and >29 U/L for females (HR 2.24, p<0.0001) were significant predictors of treatment initiation, but not practice setting.
Conclusions

Approximately 40% of treatment-eligible patients still have not started treatment on longer follow-up. Treatment rates were higher at university clinics, but practice setting was not a predictor for treatment, but older age, male gender, and higher ALT levels were. Further studies are needed to determine the barriers for treatment initiation and to improve treatment rates in treatment-eligible patients.
Keywords: CHRONIC HEPATITIS, HEPATITIS, HEPATITIS B

StephenW

BMJ开放胃肠2015年; 2：e000060 DOI：10.1136 / bmjgast-2015-000060
长期在各种实践中设置处理资格的慢性乙肝患者的随访和不理想的治疗率：联动的缝隙护理
荣ÐVu1高，Ailinh DO1，Nghia酒店ħNguyen2，百合^ h Kim1，伊ñTrinh3，伊一Nguyen3，庆ķNguyen3，我Nguyen3，安德鲁Huynh3，Mindie ^ h Nguyen1，
作者机构
胃肠病学和肝病，斯坦福大学医学中心，帕洛阿尔托，加利福尼亚州，美国1区
医学，加州大学圣地亚哥分校，加利福尼亚州，美国2School
3San何塞消化内科，圣何塞，加利福尼亚州，美国
收稿日期：
2015年8月13日
接受：
2015年9月30日
发布时间：
2015年10月21日
这是分布在依照知识共享署名非商业（CC BY-NC 4.0）的许可证，允许他人分发，混音，改编，建立在这项工作中的非商业化，并授权他们在不同的衍生作品的开放存取的文章术语，提供的原始工作正确的引用和使用是非商业。请参阅：http://creativecommons.org/licenses/by-nc/4.0/

   
抽象的
背景和目的

尽管提供有效的治疗，慢性乙型肝炎，只有少数（CHB）接受治疗。我们的目标是研究治疗率和治疗时间开始于谁符合长期随访治疗标准的患者。
方法

我们在美国的社区消化内科门诊及2007年至2011年间大学肝病门诊进行608个连续的治疗，符合条件的慢性乙肝患者的回顾性队列研究（2008年美国小组或2009年美国协会为肝脏疾病的研究（AASLD）的标准） 。观察患者，直到他们开始治疗或末次随访，如果不及时治疗。
结果

平均年龄为44，大部分是亚裔（96％​​）与社区患者年轻化和具有较低丙氨酸氨基转移酶（ALT）水平。总共有62％的人开始治疗，而38％后平均随访17个月（IQR = 1-40个月）未作处理。总体而言，处理率显著高于上大学肝病门诊比社区（66.7％对59.9％，P = 0.01）。多变量分析显示，年龄较大（HR 1.02，P = 0.002），男性（HR 1.37，P = 0.02），和基线ALT> 45 U / L的男性和> 29 U / L，女性（HR 2.24，P < 0.0001）为治疗开始的显著的预测，但没有实践的设置。
结论

大约40％的治疗符合条件的患者还没有开始接受治疗的长期随访。治疗率在大学诊所较高，但实际上设置并没有接受治疗的预测，但年龄大，男性和较高的ALT水平。还需要进一步研究，以确定治疗开始的壁垒，提高治疗率在治疗资格的患者。
关键词：慢性肝炎，肝炎，乙型肝炎