输血后丙型肝炎感染及影响因素的研究

采用回顾性定群研究方法，对济南市１１９例输血后丙型肝炎感染情况进行了调查。结果表明，１１９例受血者中，抗－ＨＣＶ阳性３１例，阳性率为２６．１％，其中１４例为临床丙型肝炎患者，罹患率为１１．７％。输入经筛检血液的受血者中，ＨＣＶ感染率和丙肝罹患率分别为１４．６％和４．２％，输入未经筛检血液者分别为３３．８％和１６．９％，差异有显著性（Ｐ＜０．０５，ＲＲ＝２．３０ＲＲ＝４．０２）。对输血量，输血次数及住院天数双向筛选法多元线性逐步回归分析表明，输血量是影响受血者感染ＨＣＶ的主要因素。     

经输血传播病毒的前瞻性调查

目的了解我国供血员、受血者中经输血传播病毒（ＴＴＶ）感染率,及经输血传播ＴＴＶ的发生率。方法对１３０例输血者进行ＴＴＶ以及ＨＢＶ和ＨＣＶ血清标志物检测,其相应的供血者也检查ＴＴＶ。结果３４０例供血员中有３６例（１０．６％）可检测到ＴＴＶ－ＤＮＡ。１３０例受血者输血前有１１例（８．５％）ＴＴＶ阳性,其余１１９例输血后有１８例ＴＴＶ转为阳性,在他们的供血中至少可查到一份ＴＴＶ阳性。４６例输血后肝炎病毒感染者中,其中有４５例为ＨＣＶ感染（包括７例与ＴＴＶ混合感染）,２例为ＨＢＶ感染（包括与ＨＣＶ、ＴＴＶ混合感染各１例）。ＴＴＶ与ＨＢＶ混合感染以及７例ＴＴＶ与ＨＣＶ混合感染中有３例的受血者ＡＬＴ＞９０Ｕ／Ｌ,但是１０例单纯ＴＴＶ感染者,仅有２例伴有轻微的ＡＬＴ增高。结论供血员及住院病人中有较高的ＴＴＶ感染率,单纯ＴＴＶ感染与ＡＬＴ显著升高似乎并无关联。     

Hepatitis B antigenemia among blood donors: the changing scene.

For the period May 1973 to August 1974 inclusive, the mean prevalence of hepatitis B antigenemia (HBsAg) in all Canadian provinces (per 100,000 population) was, for "first-time" donors, 242 and, for "repeat" donors, 77. A modification of counterimmunoelectrophoresis was used in all 16 regional transfusion centres. The findings confirm the previously noted high prevalence for the Province of Québec and the continuing relatively high prevalence for Canada. The prevalence of HBsAg among donors could be lessened by institution of the following measures: development of a more effective technique for the screening of hepatitis carriers, study of nonparenterally transmitted hepatitis, better reporting of post-transfusion hepatitis, and greater discrimination in prescribing blood and blood components.     

Chronic active hepatitis in hepatitis B surface antigen (HBsAg) carriers. The need for liver biopsy

Four cases of chronic active hepatitis were found in hepatitis B surface antigen (HBsAg) positive blood donors. Despite minimal symptoms, the full histologic spectrum of chronic hepatitis was seen. Because clinically occult liver disease can be histologically severe, liver biopsy is indicated when liver enzyme levels are persistently abnormal in long-term HBsAg carriers.     

人持续性G病毒Ⅱ型在献血者和反复接受输血患者中的检测与意义

目的确定我国献血者、反复接受输血患者HPgV-2感染率,阐明HPgV-2对血液安全的可能影响。方法运用血清学、反转 录聚合酶链反应（RT-PCR）等方法分别在1060份健康献血者、1402份HCV、500份HBV、570份反复接受输血者、248份血友病 患者共3780份血清标本中检测抗HPgV-2抗体和HPgV-2 RNA,对获得的HPgV-2 NS3片段和HPgV-2全基因组进行核酸序列 测定和分子进化分析。同时检测献血者、反复接受输血者和血友病患者血清丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）感染 情况辅助作为实验结果。结果（1）感染HCV（RNA+/Ab+）的献血者中抗HPgV-2抗体阳性率为1.21%（17/1402）,核酸阳性率 为0.36%（5/1402）,而其他几组人群中几乎未检出HPgV-2 病毒,这提示HPgV-2 感染可能主要与HCV密切相关（χ2=13.78,P= 0.004）;（2）5株HPgV-2病毒保守区域NS3区同源性达97.11%,与国外分离毒株比较,其同源性为96.53%,未发现明显变异株。 结论健康献血者中HPgV-2的感染率很低,HPgV-2主要和HCV共感染,反复接受输血患者和血友病患者没有发现HPgV-2感 染,提示HPgV-2经输血传播不常见,可能对血液安全影响不明显。     

Hepatitis B antigen in screened blood units for transfusion in renal dialysis patients

Blood units for transfusion are screened routinely in Ontario for the presence of hepatitis B antigen (HB-Ag) by counter-immunoelectrophoresis (CIEP). Since the radioimmunoassay (RIA) method is more sensitive for this purpose we used it to test blood units delivered to the hospital's Renal Dialysis Unit in order to determine if HB-Ag-carrying blood donors were being missed by the less sensitive CIEP method.

Out of the 606 blood units tested, eight were found to contain HB-Ag, an incidence of 13 out of 1000 donors. This finding indicates that the counter-immunoelectrophoresis method is insufficiently sensitive as a safe screening method for detection of hepatitis antigen.

     

Hepatitis B virus DNA and e antigen in serum from blood donors in the United Kingdom positive for hepatitis B surface antigen

Serum samples from 214 blood donors in the United Kingdom who were carriers of hepatitis B surface antigen (HBsAg) were examined for hepatitis B virus deoxyribonucleic acid (DNA) by DNA:DNA hybridisation and for hepatitis B e antigen (HBeAg) and its antibody. One fifth of the donors carried infectious virus in their circulation. The presence of hepatitis B virus DNA correlated well with that of HBeAg, although hepatitis B virus DNA was found in five serum samples that were negative for HBeAg. It is concluded that analysis of serum samples for hepatitis B virus DNA by hybridisation should be the method of choice for determining whether carriers of HBsAg are infectious.     

Prevalence of Human T Cell Leukaemia Virus amongst Blood Donors

Background

Human T cell leukaemia virus (HTLV) I/II are retroviruses implicated in transfusion transmitted infection. Present study was undertaken to assess seroprevalence of HTLV in voluntary blood donors along with pattern of blood utilisation. Methods: A total of 258 healthy blood donors who were free from infectious markers in transfusion as per current transfusion guidelines were enrolled. They were screened for HTLV-I/II antibodies by commercially available enzyme immuno assay (EIA) and their blood utilisation data was analysed.

Result

Five (1.9%) donors were found seropositive for HTLV-I/II of which 1.2 % were first time and 0.9% were repeat donors. Blood utilisation data revealed 20.9% and 38.8% units were utilised within 5 and 6–14 days of collection respectively. 45.9% recipients were transfused with single blood unit. 42.9% recipients were immunosuppressed due to underlying disease. Conclusion: The high prevalence of HTLV in blood donors, coupled with single unit transfusion, use of fresh blood, non availability of acellular blood products and immunosuppression in recipients can lead to significant transfusion transmitted HTLV infection. We suggest judicious use of blood products and screening of blood donors in prevention of transfusion transmitted HTLV-I/II.Key Words: HTLV-I/II, Blood donors; Transfusion transmitted infection; Retrovirus     

对“合格血”的受血者进行输血后肝炎的临床和血清学研究

本文对武汉市某医院132例接受“合格血”住院病例,72例非受血的住院病例,进行了半年的输血后肝炎(Posttransfusion Hepatitis PTH)的临床和血清学前瞻性调查。结果提示当前的“合格血”仍不够安全,受血2周后实验组HBsAg阳转率14.58％,对照组3.9％,相对危险性(RR)3.74,归因危险性(AR)10.68％,归因危险性百分比(AR％)73.25％,随访3个月、6个月,HBsAg在实验组分别为16.09％,4.85％,对照组分别为14.51％,8.08％(P>0.05)。4次采血完全的10例HBV标记阴性的受血者,随访6个月全部阳转。研究还提示两组在住院期间还受到输血外其他途径HBV的医源性感染。在随访观察期间未发现有显性症状的病人;仅发现19例一次性SGPT不正常,并均伴有HBV感染标记。     

The Role of anti-HBc IgM in Screening of Blood Donors

Background

Transfusion transmitted hepatitis B has always been a dreaded disease, with incidence of increased transmission through donated blood. The screening test for hepatitis B infection is detection of HBsAg that does not rule out the risk of transmission of hepatitis B as the donor may be in the ‘window period’. During this period, detection of the antibody to the hepatitis B core antigen (anti-HBc) IgM type serves as a useful serological marker. The aim of this study was to screen blood donors for anti-HBc type IgM and anti - HBc Ag total for detection and to find their incidence amongst blood donors.

Methods

2552 voluntary blood donors were screened by the ELISA method for HBsAg and anti - HBc IgM and other mandatory screening markers. 704 of the test blood samples were also screened for anti-HBc total.

Result

Of the 2552 donor, 47 (1.84 %) cases were HBsAg positive. A total of 11 (0.43 %) blood units were reactive for HBcAg IgM and of these, 10 (0.39 %) were HBsAg negative and reactive for anti-HBcAg IgM. Of the 704 samples tested for anti - HBcAg total, 112 (15.9%) samples were reactive.

Conclusion

Screening of blood for anti-HBc total is practical in the western world as the incidence of HBsAg and anti-HBc is low in these countries and these positive blood units for anti - HBcAg total can be discarded. This may not be practical in India as the incidence of anti- HBcAg total is high in our population. It is recommended that all blood units should be tested for anti - HBc IgM for infectivity status of the blood donors in the window period and to discard blood if positive.Key Words: Window period, Hepatitis B surface antigen, Anti hepatitis B core antigen     

输血后HBV、EBV、CMV感染的系列研究——Ⅰ.输血传播HBV的定群研究

用固相放射免疫法(spRIA)对150名住院受血患者进行了为期6个月输血后HBV感染的追踪观察.发现用反向间接血凝法(RPHA)检测供血员HB_sAg所致受血者HBV感染为29.33%,如果采用spRIA检测供血员HB_sAg及抗-HB_c(滴度≥1:100),可使受血者HBV感染率(11.71%)显著下降,但仍高于健康对照者(4.67%).作者提出在使用更为敏感的供血员筛检方法的同时也应重视HBV的医院内感染     

医务人员HBV和HCV感染情况分析

目的:了解医务人员的乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染现状。方法:采用ELISA法检测570名在职医务人员乙型肝炎免疫系列(HBV两对半),抗丙肝抗体(抗HCV),与同期检测孕妇228人进行有关对照。结果:共检出HBV9种免疫模式,提示为乙型肝炎病毒的不同感染状态者为60人(10.53%),与全国病毒性肝炎血清流行病学调查差异无显著性,单纯抗HBs阳性率36.49%,高于同期检测的孕妇组5.05%水平(P<0.05);抗HCV阳性率1.23%,低于1992年太原地区健康人群抽样调查4.46%(P<0.01)。结论:医务人员为肝炎病毒感染的高危人群,但接种乙肝疫苗、规范操作和做好消毒工作是预防HBV、HCV感染的有效措施;在血库、血液制品、输血、医疗器械等,与血液有关的医药卫生工作中,更应注意。     

959例输血前血源感染疾病检测结果分析

目的：通过对我院受血者输血前四项血源感染性指标的检测分析,了解本地血源感染疾病的情况,输血前检查对防范院内感染,预防医疗纠纷,提高医护人员自身保护意识的重要意义。方法：用酶联免疫吸附法（ELASA）对我院959例受血者进行输血前乙型肝炎病毒表面抗原（HBsAg）、丙型肝炎病毒抗体（抗-HCV）、人类免疫缺陷病毒抗体1＋2型（抗-HIV1＋2型）、梅毒抗体（抗-TP）四项血清学指标进行检测分析。结果：HBsAg阳性88例,占9．2％;抗-HCV阳性4例,占0．42％;抗-HIV1＋2型阳性2例（送四川省疾病预防控制中心确证阳性）,占0.21％;抗-TP阳性13例,占1．36％;输血前四项总阳性107例,阳性率11．16％。结论：对受血者输血前进行血源感染疾病的检测,可以预防院内感染,防范医疗纠纷的发生,提高医护人员的自我保护意识,具有重要的现实意义。     

Prospective study of mono-strand DNA virus (TTV) transmission by blood transfusion

AlthoughsensitiveandspecificimmunoassayandmolecularbiologicaltechniquesoftheknownhepatitisA-Evirusareavailable,theetiologyofasubstantialfractionofpost-transfusionandcom-munity-acquiredhepatitiscaseshaveremainedun-defined[1'2],hepatitisGvirus(HGV)couldbetheagentsofpartnonA-Ehepatitis,butthepathogenicityofHGVisstillremainedtobeidenti-fied,suggestingtheexistenceofadditionalcausativeagentsL"'.'].Anewhumanhepatitisre-latedviruswasisolatedbyagroupofJapanesesci-entists[6.7]-Thenewvirusisprovisio…     

A new antigen-antibody system. Clinical significance in long-term carriers of hepatitis B surface antigen.

A new antigen-antibody system was recently described in hepatitis B surface antigen (HBSAG(-positive sera. Despite indications of heterogeneity in specificity, the designations "e antigen" and "e antibodies" are used for the system as such in this articly. E'IGHT OF 17 long-term carriers of HBSAg with a histological picture of chronic persistent hepatitis or chronic aggressive hepatitis carried the e antigen, while none had demonstrable e antibodies in serum. Ten of 12 healthy carriers with e antibodies were blood donors who had donated 95 units of blood; none of these carriers was associeated with a reported case of posttransfusion hepatitis. In five individuals in the incubation stage of hepatitis B, e antigen appeared simultaneously with HBSAg but before the rise in transaminase levels. This finding further links e antigen to hepatitis B.     

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Background

This study presents data on the prevalence rate of infectious markers among voluntary and replacement donors in the blood transfusion service in Armed Forces from 2000 to 2004.

Methods

39,646 units of blood were collected from donors during the period from 2000 to 2004. All the samples were screened for hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) 1&2, hepatitis C virus (HCV), and by venereal disease research laboratory test (VDRL).

Results

24,527 (61.9%) were voluntary donations and 15,119 (38.1%) replacement donations. Prevalence of HBsAg had decreased, amongst voluntary donors from 1.67% to 0.77% but the positivity rate has not showed significant change. Seropositivity of HIV had decreased both in voluntary and replacement donors to 0.22% and 0.86% respectively. The seropositivity for anti-HCV showed steady decrease amongst voluntary donors from 0.46% to 0.20% in 2004, but in replacement donors, there was an increase in reactivity rate from 0.43% to 0.65%.

Conclusion

The increased seropositivity for HCV, HIV and HBsAg could be decreased by introduction of nucleic acid amplification testing (NAT) in minipools for HCV and HIV and introduction of anti-HBcAg (IgM) for hepatitis B virus (HBV) infection. But this may not be possible in near future in developing countries due to financial constraints. At present implementation of strict donor criteria and with use of sensitive laboratory screening tests it is possible to reduce the incidence of transfusion transmitted infections (TTI) in Indian scenario.Key Words: Transfusion transmitted infections, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus     

Hepatitis and hepatitis B surface antigen and antibody in dentists.

Dentists were surveyed regarding a history of hepatitis and the presence in the blood of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) to determine whether they were at high risk of exposure to hepatitis B virus. Of 288 Canadian dentists 5.2% gave a history of hepatitis after graduation. This proportion is similar to that for 1462 Ontario dentists (6.3%) and that for 3162 accountants (5.1%) who had previously completed a mailed questionnaire. One dentist (0.3%) was HBsAg-positive and 42 (14.6%) were anti-HBs-positive. Of 210 healthy volunteer blood donors matched for age, sex and ethnic origin with the group of dentists none was HBsAg-positive and 2.9% significantly fewer (P less than 0.005), were anti-HBs-positive. Among Ontario blood donors 0.3% were HBsAg-positive and 3% were anti-HBs-positive. Thus, in Canada, dentists are not at increased risk of acquiring clinical hepatitis or becoming carriers, but they are more likely than other groups to have anti-HBs in the blood. Among dentists from outside Canada a higher proportion had a history of hepatitis (10.3%) and were HBsAg-positive (1.6%), but approximately the same proportion were anti-HBs-positive (15.9%).     

Hepatitis-B virus infection in rural and urban populations of eastern Nigeria: prevalence of serological markers

Hepatitis B virus markers were measured by radioimmunoassay in the sera of 804 rural and urban inhabitants and prisoners in Nigeria. Of these, 530 (66%) subjects had one or more serologic markers of HBV infection; 9.1% were HBsAg carriers, 47% had anti-HBs and 10.1% were positive for anti-HBc alone. Total HBV exposure rate, HBsAg carrier rate and previous exposure to hepatitis B virus measured by the frequency of anti-HBc alone were significantly higher in the rural population compared with the urban population (p less than 0.0001; p less than 0.03; p less than 0.01) respectively. It was observed that by the age of 40 years, 87% of the Nigerian population have at least one HBV seric marker. There was a higher incidence of HBsAg (p less than 0.0001) and anti-HBc alone (p less than 0.001) in prisoners than in any other group. HBeAg was present in 16.4% HBsAg positive individuals with no intersex difference. No positive correlation was found between the frequency of HBV markers in rural dwellers and the history of blood transfusions. These findings suggest that horizontal transmission aided by cultural or behavioural factors and clustering of carriers rather than transfusions is the main determinant of HBV prevalence in rural Nigeria.     

丙型肝炎病毒在供、受血者间传播的调查

采用市售第二代抗HCVELISA试剂对一组供、受血者血清抗HCV进行了抽查。结果表明，未经地方血站抗HCV筛选的献血员血清抗HCV阳性率为18．57％，经筛选后为1．03％～5．24％，正常人群为1．98％，同期受血者为7．59％，抗HCV阳性与阴性献血者HCVRNA检测阳性率分别为56．8％与20．0％。在9例接受抗HCV阳性血液的受血者中，1例患者受血前后抗HCV均为阳性，5例抗HCV及6例HCVRNA阳转，6例血清HCV感染标志阳转者中4例ALT明显较正常为高，其中3例因临床症状较重而再次住院治疗。研究还发现3例输血感染者所接受的血液中抗HCV呈低表达状态（采用ELISA检测，OD值0．22～0．39），并对此进行了讨论。     

血液复检的意义

目的：规范临床用血的检测方法,保证用血者安全;方法：对深圳市血液中心1995年1－8月1939人次个体献血者HBsAg及抗－HCV的初、复 检结果进行回顾性分析;结果：献血后复检的1181份初检合格的献血者的血液,有34份为HBsAg阳性,占复检总份数的2.88％、有3份为抗－HCV阳性,占复检总份额的0.25％;结论：初检合格的血液,须经复检确定后才可发给病人使用。