维持性血透患者乙、丙型肝炎病毒和人免疫缺陷病毒感染随访研究

目的:调查维持性血透患者在长程血透治疗过程中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和人免疫缺陷病毒(HIV)感染情况,通过总结进一步降低血透患者上述病毒感染率。方法:收集2004年12月～2009年12月底在我院行规则维持性血液透析半年以上者共381例,每半年检查其血清HBV标志物(HBV-M)、HCV抗体(抗HCV)和抗HIV等情况;2008年1月起严格把抗HCV阳性的血液透析患者与HBsAg阳性患者单独分区和分血透机进行血液透析。比较各患者HBV-M、抗HCV和抗HIV变化情况,同时对比分区分机前后HBV和HCV感染情况。结果:(1)HBV-M检查及HBsAg抗原阳转率:2004年底～2009年底,HBsAg阳性患者分别为3,4,4,7,13,16例,增加的阳性患者均为新进入血透患者,维持性血透患者HBsAg阳转率均为0;(2)抗HCV检查及阳转率:2004年底～2009年底,抗HCV阳性患者总数分别为52例(43.3%),50例(32.3%),40例(25.8%),46例(29.9%),37例(18.8%),27例(11.3%);2005年,2006年和2007年阳转数分别为5例,2例,6例;2008年和2009年没有抗HCV阳转患者;分区分机血透后的两年和前面3年比较,抗HCV阳转率差异有统计学意义(P<0.001)。(3)抗HIV检查及阳转率:所有381例患者在随访期内没有发生抗HIV阳性。结论:在广泛应用促红素减少输血后明显降低了血透患者HBV和HCV感染率,进一步对HBV和HCV感染者采取分区分机的原则和隔离血透的治疗措施,降低了血透患者感染HBV和HCV的风险。

Incidence and Follow-up Study of HBV,HCV and HIV Infection in Uremia Patients Undergoing Maintenance Hemodialysis

Objective:To observe the incidence and follow-up of hepatitis B virus(HBV),hepatitis C virus(HCV) and human immunodeficiency virus(HIV) infections in uremia patients undergoing maintenance hemodialysis(HD) to find the clue of preventing from HBV,HCV and HIV infection.Methods:381 uremia patients who had received HD therapy more than 6 months from December 2004 to December 2009 were screened for HBV markers(HBV-M),anti-HCV and anti-HIV every 6 months,as well as the histories of blood transfusion were collected.Since January 2008,patients with anti-HCV positive and HBsAg positive were seperated in independent room and HD machine while receiving HD therapy.Data were collected and compared before and after January 2008.Results:(1)HBV-M test and sero-conversion to HBsAg positive incidence:From December 2004 to December 2009,the number of patients with HBsAg positive were 3,4,4,7,13,16 and there was no sero-conversion to HBsAg positive among HD patients.(2) Anti-HCV test and sero-conversion to anti-HCV positive incidence:From December 2004 to December 2009,the number of Anti-HCV positive were 52(43.3%),50(32.3%),40(25.8%),46(29.9%),37(18.8%),27(11.3%) and in 2005,2006 and 2007,5,2 and 6 patients who had Anti-HCV negative turned into Anti-HCV positive respectively.But there was no one with sero-conversion to anti-HCV positive in 2008 and 2009.Compared to the former 3 years,sero-conversion to anti-HCV positive incidence was significant different from that in later 2 years with independent room and HD machine.(3) Anti-HIV test and sero-conversion to anti-HIV positive incidence:no patient had anti-HIV positive and sero-conversion during this period.Conclusion:HBV and HCV infection incidence is reducing becaues EPO has been used and blood transfusion has been avoided.It is of great importence that strict isolation procedures,such as independent room and HD machine,for HBV and HCV-infected patients should be carried out.