江苏省丹阳市465例丙型肝炎病毒感染者自然转归及相关因素调查

目的 了解HCV感染者感染多年后临床和病原特征及其相关因素。方法 2012年在江苏省丹阳市对465例HCV感染者开展问卷调查、临床体征检查、血生化检测、病原检测,以明确感染者转归情况,对不同转归的感染者通过多因素logistic回归方法分析人口学特征、行为习惯、人类白细胞抗原DQ基因单核苷酸位点（rs7453920和rs2856718）、病原特征等因素对转归的影响。结果 465名HCV感染者临床表现主要为乏力（15.70%,73/465）,消化道症状（17.63%,82/465）,关节痛（10.32%,48/465）,B超肝炎病变（11.83%,55/465）,ALT值>80 IU/L（12.70%,59/465）,AST值>80 IU/L（11.18%,52/465）。HCV RNA阳性占68.60%（319/465）,病毒载量M为76.01×10⁴拷贝数/ml（592~1.08×10¹⁰拷贝数/ml）。多因素分析显示男性相比女性（OR=2.298,95%CI：1.247~4.238）、rs2856718的GA型相比AA基因型（OR=1.716,95%CI：1.070~2.752）、饮酒每周≥7次（OR=2.966,95%CI：0.979~8.988）是HCV持续感染的相关危险因素;男性（OR=1.694,95%CI：0.975~2.942）、50~岁年龄组（OR=2.414,95%CI：1.156~5.042）、有其他肝脏疾病（OR=2.592,95%CI：1.105~6.079）以及HCV RNA阳性（OR=3.479,95%CI：1.648~7.343）是肝功能异常的相关危险因素。结论 HCV感染20~30年后,病毒持续感染和肝功能异常的比例高,年龄、性别、嗜酒、个体基因特征、基础疾病是影响HCV感染转归的相关危险因素。     

Expansion of HIV screening to non-clinical venues is aided by the use of dried blood spots for Western blot confirmation

BackgroundHIV rapid testing programs in New York State (NYS) are required to collect a specimen for confirmation of a preliminary positive result; however, some venues have limited capacity to collect venous blood, and confirmation using oral fluid is restricted by cost and availability.ObjectiveTo evaluate the feasibility of using dried blood spots (DBS) at non-clinical HIV rapid testing sites for Western blot testing.Study designThe New York State Department of Health facilitated registration of 48 non-clinical HIV test sites and provided training on DBS procedures. Following a reactive rapid test, DBS were collected by fingerstick onto filter paper cards, dried and mailed to the NYS public health laboratory for Western blot testing.ResultsFrom October 2010 to December 2012, 280 DBS specimens were submitted for confirmation. Four (1.4%) were unsatisfactory for testing and 276 (98.6%) DBS were tested. Of these, 235 (85.1%) were positive, 37 (13.4%) were negative and 4 (1.4%) were indeterminate. During this period, the laboratory also received 1033 venous blood specimens for rapid test confirmation, and 35 (3.4%) were unsatisfactory. Of the 998 tested by Western blot, 784 (78.6%) were positive, 197 (19.7%) were negative and 17 (1.7%) were indeterminate.DiscussionCompared to venous blood, the percentage of rapid test referral specimens with a positive Western blot was significantly greater for DBS specimens and the frequency of unsatisfactory specimens did not differ significantly. These results indicate that DBS are a suitable alternative to venous blood for confirmation of HIV rapid tests conducted at non-clinical sites.