Adherence to chronic hepatitis B treatment guideline recommendations for laboratory monitoring of patients who are not receiving antiviral treatment.
Adherence to chronic hepatitis B treatment guideline recommendations for laboratory monitoring of patients who are not receiving antiviral treatment.
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DOI：
10.1007/s11606-010-1549-9
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发表时间：
2011-03
影响因子：
5.7
通讯作者：
Hanna, George J.
中科院分区：
文献类型：
--
作者：
Juday, Timothy;Tang, Hong;Harris, Melissa;Powers, Annette Z.;Kim, Edward;Hanna, George J.
乙型肝炎病毒 (HBV) DNA 和丙氨酸转氨酶 (ALT) 水平可预测慢性乙型肝炎 (CHB) 患者未来的并发症。为了确定何时开始抗病毒治疗，治疗指南建议至少每年监测一次 HBV DNA 和 ALT 水平。本研究旨在评估未接受抗病毒治疗的慢性乙型肝炎患者对治疗指南建议监测的遵守情况，并确定实验室监测和随后开始抗病毒治疗的预测因素。这项回顾性队列研究使用了美国大型医疗保健索赔数据库5年期间（2003年1月1日至2007年12月31日）的数据。研究人群包括年龄在 18 至 65 岁之间的患者，他们至少有两次付费医疗索赔（CHB 的 ICD-9 代码）、至少一次乙型肝炎表面抗原检测呈阳性，并且在初次诊断后至少连续参加了 12 个月的健康计划。描述性统计评估了声称进行 ALT 和/或 HBV DNA 监测的患者比例。使用多变量逻辑回归模型来确定监测和后续抗病毒治疗的预测因素。该研究纳入了 1,168 名慢性乙型肝炎患者，平均随访时间为 728 天（中位= 696 天）。至少每 12 个月监测一次的比例为 ALT 53.3%，HBV DNA 39.0%，两者均为 35.1%。监测的显着预测因素是 ALT 较高的 Deyo-Charlson 合并症指数 (DCCI) 评分（OR 1.90，p< 0.001）、HBV DNA 的男性（OR 1.49，p< 0.01）以及较高的 DCCI 评分（OR 1.10，p< 0.05）和男性（1.46，p< 0.01）。 p < 0.01) 对于两者。随后开始抗病毒治疗的重要预测因素是 HBV DNA 监测（OR 2.08，p<0.001）、较高的 DCCI 评分（OR 1.24，p<0.001）和男性（OR 1.53，p<0.01）。对未接受抗病毒治疗的慢性乙型肝炎患者的实验室监测低于指南建议，这表明抗病毒治疗的开始也可能被推迟，使患者面临疾病进展的风险。
Hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels predict future complications in chronic hepatitis B (CHB) patients. To determine when to initiate antiviral therapy, treatment guidelines recommend monitoring of HBV DNA and ALT levels at least annually. This study aimed to assess adherence to treatment guideline-recommended monitoring of CHB patients not receiving antiviral treatment and to identify predictors of laboratory monitoring and subsequent initiation of antiviral therapy. This retrospective cohort study used data from a large US health care claims database over a 5-year period (January 1, 2003 to December 31, 2007). The study population included patients 18–65 years of age with at least two paid medical claims with an ICD-9 code for CHB, at least one positive hepatitis B surface antigen test, and at least 12 months of continuous health plan enrollment after initial diagnosis. Descriptive statistics assessed the proportion of patients with claims for ALT and/or HBV DNA monitoring. Multivariate logistic regression models were used to determine predictors of monitoring and subsequent antiviral therapy. The study included 1,168 CHB patients, with a mean follow-up of 728 days (median = 696 days). The proportion monitored at least every 12 months was 53.3% for ALT, 39.0% for HBV DNA, and 35.1% for both. Significant predictors of monitoring were a higher Deyo-Charlson Comorbidity Index (DCCI) score for ALT (OR 1.90, p < 0.001), male gender for HBV DNA (OR 1.49, p < 0.01), and a higher DCCI score (OR 1.10, p < 0.05) and male gender (1.46, p < 0.01) for both. Significant predictors of subsequent initiation of antiviral treatment were HBV DNA monitoring (OR 2.08, p < 0.001), a higher DCCI score (OR 1.24, p < 0.001), and male gender (OR 1.53, p < 0.01). Laboratory monitoring of CHB patients not receiving antiviral treatment is below guideline recommendations, suggesting that initiation of antiviral therapy may also be delayed, leaving patients at risk for disease progression.
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影响因子：
120.7
作者：
Chen, CJ;Yang, HI;Iloeje, UH
通讯作者：
Iloeje, UH
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7.2
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