Screening of chronic active hepatitis from series of health examination database

Prolong existing of HBe Ag/or abnormal liver function test increase the risk of developing liver cirrhosis or hepatocellular carcinoma in patient with chronic hepatitis B/or C infection. To decrease the risk of developing hepatocellular carcinoma and liver cirrhosis by shortening the active phase of chronic hepatitis is the policy of treatment for chronic B carrier. Those available on the market like interferon, lamivudine, or ribavirin make it possible to control active viral hepatitis. In order to identify high risk groups of active hepatitis and to evaluate the validity of the screening program, a community-based study was carried out. A total of 1,935(43.6%) volunteers among 4,441 registered residents participated in this study. Similar prevalence rates as general population for HBsAg/anti-HCV were noted. In the 2nd-year examination, 1,281(66.2%) were reexamined. A pilot study was carried outto identifiy real high risk groups of CAH. From the firstly reexamined 525 subjects, 140 subjects(26.7%) with abnormal on any of HBsAg, anti-HCV, ALT and AST in their serial examinations were referred to a special clinic for liver disease, and 86 of them responded. Subjects, who were positive on either HBsAg or anti-HCV together with any elevation in serum level of AST or ALT, as well as those who were negative on both HBsAg and anti-HCV but with an elevation in serum level of AST or ALT in the second-year examination, were grouped as " candidate of active hepatitis" for most of them still in active status. Subjects, who were positive on either HBsAg or anti-HCV with a normal serum level of transaminases as well as those who were negative on both HBsAg and anti-HCV but with an elevation in serum level of AST or ALT only in the first-year examination, were grouped as "mild abnormal subjects". According to results of the pilot study, only subjects of "candidate of active hepatitis" were recruited to the clinic in later study, 53(4.1%) of all examinees meet the criteria of "candidates for active hepatitis", 38 of them visited our clinic and 21(61.9%) should be followed or treated. There were 210 " mild abnormal subjects", 66 of them visited our clinic and only 7(10.6%) should be further intervened. The sensitivity of this CAH screening was 85.1%, with a positive predictive value of 34.2%. Under the consideration of cost-benefit ratio and accessibility, this screenig model should be a reasonable and feasible way for community-based control of chronic active hepatitis.