戊型肝炎病毒感染院内筛查诊断流程的成本-效果分析

肝脏 ›› 2026, Vol. 31 ›› Issue (6): 798-803.

戊型肝炎病毒感染院内筛查诊断流程的成本-效果分析

李文静, 李自强, 李青, 谢青, 卢捷

200025 上海上海交通大学医学院附属瑞金医院感染科

收稿日期:2025-09-26 出版日期:2026-06-30 发布日期:2026-07-29
通讯作者: 卢捷,Email:lj11750@rjh.com.cn
基金资助:
中联肝健康促进中心戊型肝炎防治科研资金项目(CLH2023-F-HEV-05);上海市公共卫生体系建设三年行动计划(2023—2025年)重点学科项目(GWVI-11.1-12)

A cost-effectiveness analysis of in-hospital screening and diagnosing procedures for hepatitis E virus infection

Li Wenjing, Li Ziqiang, Li Qing, Xie Qing, Lu Jie

Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2025-09-26 Online:2026-06-30 Published:2026-07-29
Contact: LU Jie,Email: lj11750@rjh.com.cn

摘要/Abstract

摘要： 目的比较各种戊型肝炎病毒(HEV)感染筛查诊断流程的成本-效果,优化HEV感染筛查路径。方法选择上海瑞金医院7个HEV感染高风险患者较为集中或与HEV感染后肝外表现相关的临床科室,纳入2024年1月至2024年10月上述科室进行HEV抗体筛查的患者,分析不同HEV感染筛查路径的诊断效能和成本-效果。结果在2 420例入组患者中,共计检出949例(39.2%)抗-HEV IgG阳性,161例(6.7%)抗-HEV IgM阳性,115例(4.8%)HEV核酸阳性。不同科室患者抗-HEV IgG阳性率(25.6%～50.0%)、IgM阳性率(0.0%～19.7%)及 HEV 核酸阳性率(0.0%～16.5%)差异均有统计学意义(χ²值分别为 86.9、272.9及292.1,均 P<0.000 1)。96.5%(111/115)HEV RNA阳性患者就诊时ALT≥2×ULN,为825 (365,1 599)U/L。ALT异常患者HEV RNA阳性率为22.2%(111/501),显著高于 ALT正常患者的0.2%(4/1 919),差异有统计学意义(χ²=422.8,P<0.000 1)。相比在全人群同时筛查抗-HEV IgG与IgM,单独检测抗-HEV IgM可使费用减半(前者每例正确诊断成本2 664.2元,后者1 308.1元),但诊断效能接近(前者准确度97.9%,后者97.8%)。在ALT异常人群中筛查HEV抗体或核酸较全人群筛查可节约80%费用,且特异度和准确度持平。结论抗-HEV IgG检测对提升医疗机构HEV感染筛查效能作用有限,仅在ALT异常患者中进行HEV感染筛查可大幅降低检测费用。

关键词: 戊型肝炎病毒, 院内筛查, 诊断, 成本-效果

Abstract: Objective To compare the cost-effectiveness of various screening and diagnosing procedures for hepatitis E virus (HEV) infection, and optimize the HEV screening scheme in medical institutions. Methods Seven departments in Shanghai Ruijin Hospital were selected, where patients at high risk of HEV infection or bearing extrahepatic manifestations after HEV infection are relatively concentrated. Patients from these departments who tested HEV antibody from January 2024 to October 2024 were prospectively included. The accuracy rate and cost-effectiveness of various HEV screening and diagnostic strategies were compared. Results Among 2,420 enrolled subjects, 949 (39.2%), 161 (6.7%) and 115 (4.8%) patients were positive for anti-HEV IgG, anti-HEV IgM and HEV RNA, respectively. There were statistically significant differences of anti-HEV IgG positive rate (25.6%~50.0%), IgM positive rates (0.0%~19.7%) and HEV RNA positive rates (0.0%~16.5%) among departments (χ²=86.9, 272.9 and 292.1, respectively, all P<0.000 1). The vast majority of patients with positive HEV RNA had abnormal alanine aminotransferase (ALT) levels (≥2×ULN) at the time of admission (111/115, 96.5%), with a median ALT level of 825 U/L (interquartile range 365~1 599 U/L). The HEV RNA positive rate was significantly higher in the patients with abnormal ALT (111/501, 22.2%) than those patients with normal ALT (4/1 919, 0.2%) (χ²=422.8, P<0.000 1). Compared with simultaneously detecting anti-HEV IgG and IgM, the cost of detecting anti-HEV IgM alone was halved (2 664.2 CNY vs. 1 308.1 CNY for diagnostic cost per case with HEV infection), and the accuracy rate was comparable (97.9% vs. 97.8%). Screening for HEV antibodies or nucleic acid markers in the ALT-abnormal population saved 80% of the cost compared with screening in the general population, while the specificity and accuracy were basically unchanged. Conclusion The detection of anti-HEV IgG has limited contribution in improving the screening efficiency of HEV infection. Conducting HEV screening only in patients with abnormal ALT levels can significantly reduce medical expenses.

Key words: Hepatitis E virus, In-hospital screening, Diagnosis, Cost-effectiveness

李文静, 李自强, 李青, 谢青, 卢捷. 戊型肝炎病毒感染院内筛查诊断流程的成本-效果分析[J]. 肝脏, 2026, 31(6): 798-803.

Li Wenjing, Li Ziqiang, Li Qing, Xie Qing, Lu Jie. A cost-effectiveness analysis of in-hospital screening and diagnosing procedures for hepatitis E virus infection[J]. Chinese Hepatolgy, 2026, 31(6): 798-803.

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