HIV感染者的血液学检测分析与研究

目的:对HIV感染者做相关的血液学检测,分析HIV感染者合并感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)的现状及其预后,为揭示HIV、HBV、HCV混合感染的规律,为预防、治疗及判断HIV混合感染的预后提供科学依据.方法:按照国家检验标准,对我市120例HIV感染者进行CD4 、CD8 T淋巴细胞计数,丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)检测,HBV五项、抗HCV检测,检测结果做相关性和差异性统计学分析.结果:120例HIV感染者中,合并HBV、HCV感染者71例,占所有HIV感染者的59.17%,其中合并HBV感染者50例,占HIV感染者的41.67%,合并HCV感染者39例,占HIV感染者32.5%.HIV/HBV、HIV/HCV、HIV/HBV/HCV 3种合并感染者的CD4 T淋巴细胞计数明显低于HIV单一感染者(P均＜0.05),HIV/HCV、HIV/HBV/HCV混合感染者的ALT、AST异常比例明显高于HIV单一感染(P均＜0.05).结论:HIV感染者合并HBV、HCV感染现状严重.HIV合并感染肝炎病毒后,可以加速肝脏和免疫系统的损害,导致HIV感染者更高的发病率和死亡率,加快HIV感染者疾病的进程,降低抗逆转录病毒治疗(HAART)的效果,应引起更多的重视,尽早采取措施,提高HIV感染者的防治效果.     

机械热力清洗消毒技术与供应室人员的职业安全

医疗器械使用后，不仅污染了大量的细菌，带血的器械还可能污染大量的乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、输血性肝炎病毒（TTV）、人免疫缺陷病毒（HIV）等经血传播的病毒。医务人员血源感染的主要途径是感染性血液及体液进入其血液，进人方式包括被污染的锐器刺伤，破损的皮肤或黏膜接触污染的血液和体液等。殷小基收集了2001年6月1日-2002年5月31日东华医院24例锐器伤害员工资料，受伤人员中受伤率最高为护士，占54．2％.     

医疗废物管理的迫切性

医疗废物是指医疗卫生机构在诊断、治疗、卫生处理过程中产生的废物和患者生活过程中产生的排泄物及垃圾。医疗废物最常见的危害是针头、刀片等锐器造成的伤害，一旦锐器被HIV、HBV、HCV污染，被刺者就可能发生相关的传染病感染。     

职业暴露于血传病毒的预防及处理

职业暴露包括眼、口、其它粘膜或破损皮肤及胃肠外途径与血液或其它受污染物接触等方式。本文报道健康护理人员职业暴露于三种血传病毒——乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)及人免疫缺陷病毒(HIV)后的预防和治疗对策。 HBV:经粘膜或损伤皮肤接触传播HBV的途径已被证实,估计经皮损引起血液传播的危险性为2～40％,可能比HCV和HIV     

口腔医疗机构医院感染及微生物污染现状调查

目的:增强医务人员的自身防护意识,减少医源性感染的发生.方法:采口腔科医务人员血清150份,口腔医疗器械221份用ELISA方法进行HBV、HCV、HIV检测,44份口腔治疗椅系统水样品及221份13腔医疗器械进行菌落计数及部分样品的细菌分离鉴定.结果:150份血清样品HBV感染率为37.33%(56/150),HCV的感染率1.3%(2/150),HIV未检出.221份口腔医疗器械HBV感染率为1.36%(3/221),HCV、HIV未检出,微生物检出率为14.03%(31/221),44份13腔治疗椅系统水样品的细菌检出率为77.27%(34/44).结论:口腔医疗机构微生物污染现象比较严重,应加强预防消毒管理.     

有偿献血者HIV-1、HCV、HBV合并感染调查

目的调查山西省农村某既往有偿献血地区人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）合并感染状况。方法对4个村年龄18～59岁的村民进行问卷调查和血样采集，检测项目包括HIV-1抗体、HCV抗体和HBV表面抗原（HBsAg）。结果人群HIV、HCV、HBV感染率分别为1．3％（40／3062），12．7％（389／3062），3．5％（103／2982）；40名HIV感染者中，85．0％伴HCV感染，2．5％伴HBV感染。多因素Logistic回归分析提示，既往有偿献血（浆）史是HIV、HCV及HIV／HCV合并感染的危险因素，而与HBsAg阳性呈负相关，过去5年外出打工史与HIV、HBsAg、HIV／HCV感染差异有统计学意义；未发现吸毒、终生性伴数、婚外性行为、商业性行为和各种性行为中安全套的使用与HIV、HCV、HBV感染及合并感染有关联。结论应重点关注HIV、HCV和HBV感染者的治疗、健康教育和行为干预。     

HIV感染者HCV、HBV、TP重叠感染及其危险因素

目的 了解郑州市人类免疫缺陷病毒(HIV)感染者丙型肝炎病毒(HCV)、乙型肝炎病毒(HBV)、梅毒(TP)重叠感染情况,分析危险因素.方法 对郑州市确证HIV感染者问卷调查及HCV、HBV、TP感染检测,分析重叠感染的危险因素.结果 264例HIV感染者HCV、HBV、TP重叠感染发生率为63.64％,其中重叠感染H...     

HIV感染者混合感染HBV、HCV的调查研究

目的分析常德市近13年来人类免疫缺陷病毒(HIV)合并感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)状况及其预后,为揭示HIV、HBV、HCV混合感染规律,为HIV的预防、治疗及判断预后提供科学依据。方法按照国家标准检验方法对常德市120例HIV感染者进行CD4 、CD8 T淋巴细胞计数,丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)检测,HBV五项、抗HCV检测,对检测结果做系统的比较和分析。结果120例HIV感染者中,以青壮年为主要人群,以性传播为主要感染方式;混合HCV、HBV感染者有71例,占所有HIV感染者的59.17%。混合感染中,男性明显多于女性(P<0.05),血液传播和静脉吸毒为主要的感染方式,且HIV/HCV,HIV/HBV/HCV混合感染的ALT、AST异常比例明显高于HIV单独感染(P<0.05),HIV/HBV、HIV/HCV、HIV/HBV/HCV三种感染模式的CD4 T淋巴细胞计数明显低于HIV单一感染(P<0.05)。结论HIV感染者混合感染HBV、HCV现状日趋严重,特别在经血液传播、静脉吸毒传播的男性HIV感染人群中更加明显。HIV与多种肝炎病毒合并感染可能加速肝脏和免疫系统的损害,导致更高的发病率和死亡率,影响HIV感染的进程及高效抗逆转录病毒治疗(HAART)。     

48例静脉药瘾者多重病毒感染临床分析

目的探讨静脉药瘾病毒性肝炎患者多重病毒感染率及转归。方法对48例静脉药瘾病毒性肝炎患者进行乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、人免疫缺陷病毒（HIV）血清标志物及核酸测定,并进行临床分析。结果48例静脉药瘾病毒性肝炎患者中,HBV、HCV双重感染率为31.25%,HBV、HIV双重感染率为4.17%,HBV、HCV、HIV三重感染率为62.50%;重型肝炎者占70.83%。重型肝炎患者住院时间为（48.67±19.25）d,与同期住院的非药瘾重型肝炎患者住院时间（65.32±31.49）d相比,明显缩短（U=4.25,P＜0.01）。结论静脉药瘾者病毒重叠感染率高,且重型肝炎患者多,但相对非药瘾重型肝炎患者恢复较快。     

受血者受血前HIV、HBV、 HCV、梅毒感染及其重叠感染研究

目的研究受血者受血前人免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、梅毒感染及其重叠感染现状与特点。方法对2007年10月-2008年6月间某院需输注血制品的9694例患者进行检测;采用酶联免疫吸附试验检测血清HBV标志物、血清抗HCV,双抗原夹心酶联免疫法检测血清抗HIV和梅毒抗体。结果9694例受血者受血前血清HBV标志物阳性1549例（15．98％）,抗HCV阳性59例（0．61％）,抗HIV阳性34例（0．35％）,梅毒抗体阳性495例（5．11％）。重叠感染者中,HBV与HCV57例（0．59％）,HBV与梅毒94例（0．97％）,HCV与梅毒3例（0．03％）;血清抗HIV阳性患者中,重叠感染HBV13例（0．13％）,HCV10例（0．10％）,梅毒4例（0．04％）;HIV、HBV和HCV重叠,HIV、HBV和梅毒重叠感染各2例（1．08％）,HIV、HBV、HCV和梅毒重叠感染1例（0．54％）。结论部分受血者在受血前就已有感染,特别是HBV和梅毒的感染率较高。对受血者于受血前进行全面检查不仅可避免相关医疗纠纷,还可为患者治疗和医务人员的职业防护提供帮助。     

Sharps discarded in inner city parks and playgrounds--risk of bloodborne virus exposure

The objectives of this study were to determine the number of discarded syringes found in four parks in Southwark, South London, over a specific time period and to test their contents for the presence of hepatitis B virus (HBV) and hepatitis C virus (HCV). Of 106 syringes collected over a four-month period, evidence of HBV was detected in 4.7% (5/106) and HCV in 4.7% (5/106). Urban children, park users and workers are at risk of contact with sharps which may be contaminated with both viruses. Park users need more information on what to do in the event of an injury, and park workers should be immunised against HBV and educated on safe disposal of sharps.     

Bloodborne pathogen exposures in a developmental center: 1993-2000.

In a developmental center, 257 potential bloodborne pathogen exposures (119 bites, 91 scratches, 30 sharps injuries, 17 mucosal breaks) occurred during 8 years (13,187 employee-years and 6,980 resident-years). Of the residents, 9% were hepatitis B virus (HBV) surface antigen carriers. Serological follow-up of exposed, susceptible employees and residents identified no transmission of HBV, hepatitis C virus (HCV), or human immunodeficiency (HIV) virus. This outcome has been due primarily to hepatitis B immunization and low prevalences of HCV or HIV infections among the subjects. Proper follow-up of all potential exposures is crucial to identify transmission promptly, allay anxiety, and prevent unwarranted workmen's compensation claims. Measures are suggested to reduce exposure further.     

某三级综合医院医务人员职业暴露调查

目的了解某三级综合医院医务人员职业暴露情况,分析职业暴露发生原因及预防对策。方法对某院2010年1月—2013年12月134例发生职业暴露的医务人员进行调查。结果暴露人群中,护士所占比率最高(59.70%),其次是医生(19.40%)、医技人员(9.70%)。职业暴露主要原因为锐器管理不规范(占46.27%,62例),其次为操作意外(占42.54%,57例)、防护措施不足所致(占11.19%,15例);暴露方式以锐器伤为主(占94.78%,127例),黏膜接触暴露占5.22%(7例),暴露源不明确者占42.54%,暴露源明确者占57.46%,其中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)、人类免疫缺陷病毒(HIV)分别占35.82%、12.69%、3.73%、2.24%;HBV、HCV合并感染占2.24%(3例);HIV、HBV、HCV、TP合并感染占0.74%(1例)。职业暴露后正确处理率为95.52%。结论护士是职业暴露高危群体,做好职业防护,并规范锐器管理,可以减少医务人员职业暴露发生。     

Risk of infections associated with improperly reprocessed transrectal ultrasound-guided prostate biopsy equipment.

OBJECTIVE: A hospital discovered a lapse in the reprocessing procedures for transrectal ultrasound-guided prostate biopsy equipment. An investigation was initiated to assess the risks of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and bacteria during prostate biopsies. METHODS: We offered testing for HBV, HCV, and HIV infection to patients who had undergone prostate biopsies from January 30, 2003, through January 27, 2006. We reviewed their medical records and obtained information on the reprocessing procedures that were in use at the time for the prostate biopsy equipment. SETTING: A healthcare facility in Maine. RESULTS: Of the 528 patients exposed to improperly reprocessed prostate biopsy equipment, none tested positive for HIV or HCV. Sixteen patients (3%) tested positive for past HBV infection but had no prebiopsy HBV serologic test results available (ie, transmission from improperly reprocessed biopsy equipment was possible), and 11 (2%) had evidence of postbiopsy bacterial infections. The number of cases of HBV and bacterial infections were within reported ranges for this population and were not clustered in time. Review of the reprocessing procedures in use at the time revealed that the manufacturer-recommended brushes for cleaning the reusable biopsy needle guide were never used. Brushes did not come with the equipment and had to be ordered separately. CONCLUSIONS: Despite the lack of evidence of pathogen transmission in this investigation, it is critical to review the manufacturer's reprocessing recommendations and to establish appropriate procedures to avert potential pathogen transmission and subsequent patient concerns. This investigation provides a better understanding of the risks associated with improperly reprocessed transrectal ultrasound prostate biopsy equipment and serves as a methodologic tool for future investigations.     

347例HIV/AIDS患者外周血免疫细胞表达水平的临床意义

目的 分析HIV/AIDS患者外周血免疫细胞的表达水平随CD4+淋巴细胞数量、白蛋白含量、HIV-RNA载量以及合并感染的变化情况,探讨其检测的临床意义。方法 回顾性分析347例HIV/AIDS患者外周血的临床资料,对CD4+、CD8+、B淋巴细胞、自然杀伤细胞(NK)的绝对数、白蛋白(ALB)含量、HIV-RNA载量以及梅毒螺旋体抗体(TP)、乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)抗体的检测结果进行统计学分析。结果 CD4+含量降低组的HIV/AIDS患者CD8+、B、NK细胞的表达水平低于正常组患者(P<0.01),CD8+、NK、B细胞的含量与CD4+数量呈正相关(P<0.05);白蛋白含量降低组的HIV/AIDS患者CD4+、CD8+、B、NK细胞的表达水平低于正常组的患者(P<0.01),白蛋白含量与CD4+、CD8+、B、NK细胞的数量呈正相关(P<0.01);HIV-RNA阳性患者CD4+、CD8+、B、NK细胞的表达水平低于阴性患者(P<0.01),合并感染率为27.9%,高于阴性患者22.5%(P<0.05),HIV-RNA载量与CD4+、B淋巴细胞含量呈负相关(P<0.05)。结论 CD8+、B、NK细胞的表达水平以及合并感染率与疾病的进展密切相关,对于新发现的HIV/AIDS患者,同时检测血清中TP/HBV/HCV抗体,能准确地掌握合并感染情况,有利于实施个体化治疗方案。     

储存时间对消毒后软式内镜微生物污染的影响

目的 监测消毒后软式内镜在存放不同时间的微生物污染情况，以探讨软式内镜的安全储存期。方法 采用便利抽样法选取重庆市某三甲医院内镜中心的27条软式内镜进行前瞻性研究，2017年10月-2019年2月，纳入消毒后内镜生物学监测合格的内镜，并常温下储存24、48、72、168 h，监测内镜管腔及表面菌落数及其合格率，同时监测镜柜空气与物体表面菌落数及其合格率。结果 108条次软式内镜分别储存24、48、72、168 h，内镜管腔与表面菌落合格率均为100%。其中108条次内镜储存24、48、72、168 h的表面菌落数为0；108条次内镜储存24、48、72 h的管腔菌落数为0，储存168 h 107条次内镜管腔菌落数为0，1条次内镜管腔菌落数为6 CFU/件，但无致病菌。镜柜空气与物体表面菌落数合格率均为100%。结论 软式内镜高水平消毒合格后在合格环境下储存168 h是安全的，使用前可不必再消毒。     

Hepatitis B and C infections, human immunodeficiency virus and other sexually transmitted infections among women of childbearing age in C?te d'Ivoire, West Africa.

Few studies have been conducted in developing countries to estimate the prevalence of hepatitis C virus (HCV) infection and its association with human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). We have screened for hepatitis B virus (HBV) and HCV markers 200 HIV-1-positive, 23 HIV-2-positive and 206 HIV-negative women attending gynaecology clinics in 1995/96 in Abidjan, C?te d'Ivoire, a sample selected among 2198 consecutive consultants. Taking into account the prevalence of 21.7% for HIV in this population, the overall prevalence of anti-HBV core antibody was 81.6%, that for hepatitis B surface antigen was 9.9% and for HCV antibody was 3.3%. HIV infection and other STDs were not associated with HBV or HCV markers. Moreover, HBV and HCV markers were not statistically associated. Our results confirm the high prevalence of HIV in Abidjan and the endemic situation of HBV infection. Furthermore, HCV infection is not infrequent in this developing country setting, not explained by sexual transmission.     

湖北吸毒人群中HIV、HBV、HCV、HGV、TTV感染情况调查

目的 了解湖北吸毒人群中HIV、HBV、HCV、HGV及TTV感染情况。方法 对湖北某戒毒所及本科室门诊的吸毒者进行调查并采静脉血分离血清作抗HIV、HBsAg、抗HCV、抗HGv、抗TTV检测。结果 89例吸毒者中，发现HIV阳性2例，阳性率为2．2％；FIBsAg阳性9例，阳性率为10．1％；HCV阳性51例，阳性率为57．3％；HGV阳性48例，阳性率为53．9％；42例吸毒者检查TTV，阳性25例，阳性率为59．5％。结论 在静脉吸毒人群中存在着较高的血传播病毒感染，且多为合并感染。湖北吸毒人群中的HIV感染尚为传入阶段，亟需采取有力措施控制HIV在吸毒人群中的传播。     

Occupational injuries and exposures among Canadian dentists: the results of a national survey.

OBJECTIVES: To measure the frequency of occupational exposures reported by dentists in Canada and to identify factors associated with occupational exposure. DESIGN: A national mailed survey of a stratified random sample of 6,444 dentists with three follow-up attempts. Weighted data were analyzed using t tests, analysis of variance, and multiple logistic regression. RESULTS: The response rate was approximately 66%. Occupational exposures, percutaneous injuries, and mucous membrane exposures in the last year were reported by 67%, 62%, and 29% of respondents, respectively. Fewer than 1% reported exposure to human immunodeficiency virus or hepatitis B virus (HBV). Respondents reported means of 1.5 mucous membrane and 3.0 percutaneous exposures per year. HBV immunization was reported by 91% of dentists, but of these 28% reported no post-immunization serology. Other reports of suboptimal compliance included use of a postexposure protocol by only 41% and HBV vaccination of all assistants or of hygienists by 74% and 77% of respondents, respectively. Factors associated with percutaneous exposure included non-use of postexposure protocol or puncture-proof containers for sharps disposal, treating > or =20 patients per day, and male gender. Risk factors for mucous membrane exposure included non-use of eye protection or masks. CONCLUSION: This study provides evidence of the protective effect of puncture-proof containers, eye protection, and masks and raises concerns related to HBV post-immunization serology and postexposure protocols. To reduce risk of infection, educational interventions are required to improve compliance with Universal Precautions, with emphasis on comprehensive HBV immunization and post-immunization serology, the use of barriers, puncture-proof containers for sharps disposal, and postexposure protocols.