婴儿潮一代丙型肝炎筛查的实施及在胃肠病学实践中与护理的联系：一项多中心试点研究。
Implementation of baby boomer hepatitis C screening and linking to care in gastroenterology practices: a multi-center pilot study.
作者信息
Younossi Zobair M, LaLuna Louis L, Santoro John J, Mendes Flavia, Araya Victor, Ravendhran Natarajan, Pedicone Lisa, Lio Idania, Nader Fatema, Hunt Sharon, Racila Andrei, Stepanova Maria
机构信息
Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
Center for Outcomes Research in Liver Diseases, Washington, DC, USA.
出版信息
BMC Gastroenterol. 2016 Apr 4;16:45. doi: 10.1186/s12876-016-0438-z.
BACKGROUND
Estimates suggest that only 20 % of HCV-infected patients have been identified and <10 % treated. However, baby boomers (1945-1965) are identified as having a higher prevalence of HCV which has led the Centers for Disease Control and Prevention to make screening recommendations. The aim of this study was to implement the CDC's screening recommendations in the unique setting of gastroenterology practices in patients previously unscreened for HCV.
METHODS
After obtaining patient informed consent, demographics, clinical and health-related quality of life (HRQOL) data were collected. A blood sample was screened for HCV antibody (HCV AB) using the OraQuick HCV Rapid Antibody Test. HCV AB-positive patients were tested for presence of HCV RNA and, if HCV RNA positive, patients underwent treatment discussions.
RESULTS
We screened 2,000 individuals in 5 gastroenterology centers located close to large metropolitan areas on the East Coast (3 Northeast, 1 Mid-Atlantic and 1 Southeast). Of the screened population, 10 individuals (0.5 %) were HCV AB-positive. HCV RNA testing was performed in 90 % (9/10) of HCV AB-positive individuals. Of those, 44.4 % (4/9) were HCV RNA-positive, and all 4 (100 %) were linked to caregiver. Compared to HCV AB negative subjects, HCV AB-positive individuals tended to be black (20.0 vs. 5.2 %, p = 0.09) and reported significantly higher rates of depression: 60.0 vs. 21.5 %, p = 0.009. These individuals also reported a significantly lower HRQOL citing having more fatigue, poorer concentration, and a decreased level of energy (p < 0.05).
DISCUSSION
Although the prevalence of HCV AB-positive was low in previously unscreened subjects screened in the gastroenterology centers, the linkage to care was very high. The sample of patients used in this study may be biased, so further studies are needed to assess the effectiveness of the CDC screening recommendations.
CONCLUSION
Implementation of the Baby Boomer Screening for HCV requires identifying screening environement with high prevalence of HCV+ individuals as well as an efficient process of linking them to care.
背景
据估计，只有20%的丙型肝炎病毒（HCV）感染患者被确诊，接受治疗的患者不到10%。然而，婴儿潮一代（1945 - 1965年出生）被认为感染HCV的患病率较高，这促使疾病控制与预防中心（CDC）提出筛查建议。本研究的目的是在胃肠病学诊疗机构这一独特环境中，对之前未接受过HCV筛查的患者实施CDC的筛查建议。
方法
在获得患者知情同意后，收集人口统计学、临床及健康相关生活质量（HRQOL）数据。使用奥奎克HCV快速抗体检测法对血液样本进行HCV抗体（HCV AB）筛查。HCV AB阳性患者进行HCV RNA检测，若HCV RNA呈阳性，则与患者进行治疗讨论。
结果
我们在东海岸靠近大城市的5个胃肠病学中心筛查了2000人（3个在东北部，1个在大西洋中部，1个在东南部）。在筛查人群中，10人（0.5%）HCV AB呈阳性。90%（9/10）的HCV AB阳性个体进行了HCV RNA检测。其中，44.4%（4/9）HCV RNA呈阳性，且所有4人（100%）均与护理人员有关联。与HCV AB阴性受试者相比，HCV AB阳性个体往往为黑人（20.0%对5.2%，p = 0.09），且报告的抑郁症患病率显著更高：60.0%对21.5%，p = 0.009。这些个体还报告称HRQOL显著较低，表现为疲劳感更强、注意力更差以及精力水平下降（p < 0.05）。
讨论
尽管在胃肠病学中心筛查的之前未接受过检测的受试者中HCV AB阳性患病率较低，但护理关联度非常高。本研究中使用的患者样本可能存在偏差，因此需要进一步研究以评估CDC筛查建议的有效性。
结论
实施婴儿潮一代HCV筛查需要识别HCV阳性个体患病率高的筛查环境，以及将他们与护理有效关联的流程。
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