中国北京慢性乙型肝炎患者临床护理级联变化

StephenW

中国北京慢性乙型肝炎患者临床护理级联变化
李敏1、赵连辉2、周嘉玲2、孙亚梦2、吴晓宁2、欧小娟2、鸿友2、园园1、冀东嘉2
隶属关系
隶属关系

    1
    首都医科大学附属北京友谊医院国家消化系统疾病临床研究中心临床流行病学与循证医学科，北京 100050。
    2
    首都医科大学附属北京友谊医院肝脏研究中心，北京 100050

    PMID：34590058 PMCID：PMC8406027 DOI：10.1016/j.lanwpc.2021.100249

抽象的

背景：需要大量接受乙型肝炎病毒 (HBV) 检测和抗病毒治疗，以改善人群水平的慢性乙型肝炎 (CHB) 患者的临床结果。在目前的研究中，我们使用员工基本医疗保险（BMCIE）来调查中国北京 CHB 临床护理级联的变化。

方法：从BMCIE数据库中检索2010年1月1日至2018年12月31日CHB患者就医记录。计算接受护理、接受 HBV 检测和抗病毒治疗的 CHB 患者的年度和累积率。使用 Joinpoint 回归模型估计年度百分比变化 (APC) 的趋势。

结果：在估计的 HBsAg 阳性员工中，接受护理的 CHB 患者率从 2010 年的 4•77% 增加到 2018 年的 18•61%（APC=17•3，95%CI：14•4-20•4）。乙肝病毒检测率从2010年的4•41%提高到2018年的16•39%。在估计符合条件的员工中，抗病毒治疗率从2010年的3•92%提高到2018年的30•88%。每年HBV≥4次就诊的比例从2010年的47•07%上升到2018年的65•31%。到2018年，恩替卡韦（65•07%）和替诺福韦（12•98%）成为主要是处方抗病毒药物。

解释：在中国北京，慢性乙肝患者接受护理、接受 HBV 检测和抗病毒治疗的比率大幅增加。然而，仍需要做出更多努力来增加 HBV 检测和治疗的采用，以实现到 2030 年消除 HBV 的目标。

基金资助：北京市科委（No.D161100002716003）、国家传染病重大科技专项（No.Z191100007619037、No.2018ZX10302204）、消化内科协调发展中心（北京市第XXX号） 0104）。

关键词：抗病毒治疗；慢性乙型肝炎;临床护理级联；诊断。

© 2021 作者。由爱思唯尔有限公司出版。

StephenW

Changing clinical care cascade of patients with chronic hepatitis B in Beijing, China
Min Li  1 , Lianhui Zhao  2 , Jialing Zhou  2 , Yameng Sun  2 , Xiaoning Wu  2 , Xiaojuan Ou  2 , Hong You  2 , Yuanyuan Kong  1 , Jidong Jia  2
Affiliations
Affiliations

    1
    Department of Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
    2
    Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.

    PMID: 34590058 PMCID: PMC8406027 DOI: 10.1016/j.lanwpc.2021.100249

Abstract

Background: High uptake of hepatitis B virus (HBV) tests and antiviral therapy are required to improve the clinical outcomes of patients with chronic hepatitis B (CHB) at the population level. In the current study, we used the Basic Medical Care Insurance for Employees (BMCIE) to investigate the changes of clinical care cascade of CHB in Beijing, China.

Methods: Records for medical service of CHB patients from January 1, 2010 to December 31, 2018 were retrieved from the BMCIE database. The annual and cumulative rates of CHB patients in care, receiving HBV tests and on antiviral therapy were calculated. The trends of annual percentage changes (APCs) were estimated using Joinpoint regression model.

Findings: Among estimated HBsAg positive employees, the rate of CHB patients in care increased from 4•77% in 2010 to 18•61% in 2018 (APC=17•3, 95%CI: 14•4-20•4). The rate of HBV tests increased from 4•41% in 2010 to 16•39% in 2018. Among the estimated eligible employees for treatment, the rate of antiviral therapy increased from 3•92% in 2010 to 30•88% in 2018. The proportion of hospital visits for HBV≥4 times per year had increased from 47•07% in 2010 to 65•31% in 2018. By 2018, entecavir (65•07%) and tenofovir (12•98%) had become the predominantly prescribed antiviral agents.

Interpretation: The rates of CHB patients in care, receiving HBV tests and on antiviral therapy substantially increased in Beijing, China. However, more efforts are still needed to increase the uptake of HBV tests and treatment for achieving the goal of HBV elimination by 2030.

Funding: Beijing Municipal Science and Technology Commission (No.D161100002716003), National Science and Technology Major Special Project for Infectious Diseases (No.Z191100007619037, No.2018ZX10302204), and Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (No. XXX 0104).

Keywords: Antiviral therapy; Chronic Hepatitis B; Clinical care cascade; Diagnosis.

© 2021 The Author(s). Published by Elsevier Ltd.

StephenW

www.thelancet.com/article/S2666606521001589/pdf