Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis

To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia.     

Hemolytic anemia after kidney transplantation: a prospective analysis

BACKGROUND: Hemolysis may occur in 9% to 40% of patients after solid organ transplantation and be caused by the passenger lymphocyte syndrome (PLS). STUDY DESIGN AND METHODS: We have prospectively examined 217 kidney transplant recipients before (Day ?1) and after (up to Days +10, +20, and +30) surgery. ABO‐identical transplant was performed in 180 (82.9%) patients, while 37 (17.1%) individuals received ABO‐compatible nonidentical grafts. Direct antiglobulin tests (DATs) were performed by tube technique (polyspecific anti‐human globulin [IgG + C3d]), positive DAT samples were further tested by gel agglutination (monospecific anti‐IgG, ‐IgM, ‐IgA, or ‐C3), and eluates were prepared from DAT‐positive red blood cells (RBCs) by the dichloromethane elution test. RESULTS: We observed that 34 of 217 (15.7%) patients developed a positive DAT up to Day +30. The percentage of patients with positive DATs was significantly higher in those having ABO‐compatible nonidentical transplants compared to those that received ABO‐identical grafts (10/37 = 27.0% vs. 24/180 = 13.3%; p = 0.037). Specific RBC antibodies (anti‐A or anti‐B) were found in only 5 of 37 (13.5%) patients having ABO‐compatible nonidentical transplants who presented with clinical hemolysis. We found only three reactive eluates from 24 patients with positive DATs who received ABO‐identical transplants but had no hemolysis. CONCLUSIONS: Our data collected prospectively demonstrated that: 1) positive DATs occurred in 15.7% of all patients up to Day +30 after a kidney transplant; 2) the DAT positivity occurred up to Day +10 in 9.7% of all transplanted patients; 3) the majority of the transplant recipients with a positive DAT had a nonreactive RBC eluate; and 4) PLS was the cause of a positive DAT in 13.5% of patients submitted to ABO‐compatible nonidentical kidney transplants.     

RBC-associated IgG in patients with visceral leishmaniasis (kala-azar): a prospective analysis

BACKGROUND: Despite the fact that anemia is one of the most striking clinical features of visceral leishmaniasis (kala-azar), the factors involved in its pathogenesis are not fully understood. Although the cause of the anemia seen in these patients is often multifactorial, sequestration and destruction of the RBCs in the enlarged spleen, immune mechanisms, and alterations in RBC membrane permeability have been implicated. STUDY DESIGN AND METHODS: To investigate whether RBCs of patients with kala-azar were coated with IgG, blood samples of 67 patients were tested, prospectively, before (Day 1), during (Day 30), and after (Day 90) antimonial therapy, to examine the presence of RBC-associated IgG, circulating immune complexes (CICs), and rheumatoid factor (RF). RESULTS: The prevalence of a positive DAT on Day 1 was significantly greater than the prevalence of a positive DAT performed on Day 30 and on Day 90 (32.8 vs. 4 vs. 0%, p < 0.001). With an enzyme-linked antiglobulin test (ELAT) to measure the number of IgG molecules per RBC more accurately, it was found that the amount of IgG molecules per RBC was increased (mean, 298 molecules of IgG per RBC) in the group of patients with kala-azar tested before antimonial therapy, but was considered normal (<50 molecules of IgG per RBC) in all patients tested 90 days after treatment. The prevalence of a positive eluate test was low (15.0%) in DAT (anti-IgG)-positive patients and the positivity of DATs and ELATs correlated with the presence of either RF or CICs, respectively. CONCLUSIONS: These data suggest that a nonspecific adsorption of CICs on the RBC surface is probably the most important factor involved in the increased amount of RBC-associated IgG in patients with untreated visceral leishmaniasis; however, further prospective studies are required to establish the exact role of the RBC-associated antibodies, CICs, and RF as contributing factors of the anemia seen in these patients.     

Anti-cardiolipin antibodies in patients with chronic viral hepatitis are independent of beta2-glycoprotein I cofactor or features of antiphospholipid syndrome

BACKGROUND: Although controversial, some authorities have implicated hepatitis C virus (HCV) as a cause of anti-phospholipid syndrome (APLS). Anti-cardiolipin antibodies (anti-CLAbs) in APLS are cofactor-dependent ('pathogenic' antibodies). We conducted a study in order to determine the prevalence of anti-CLAbs in HCV patients, and furthermore to address whether these autoantibodies are cofactor-dependent or not and whether they are associated with features of APLS. Patients with hepatitis B virus (HBV) were also evaluated in order to assess whether there are differences in the prevalence and the clinical significance of anti-CLAbs between these two major types of chronic viral hepatitis. MATERIALS AND METHODS: One hundred and seventy-four consecutive HCV patients, 50 HBV patients and 267 healthy were investigated for the presence of anti-CLAbs and antibodies against beta2-glycoprotein I (beta2-GPI), which is the most important cofactor of the 'pathogenic' anti-CLAbs in APLS. IgG anti-CLAbs were determined by an in-house quantitative ELISA and anti-beta2-GPIAbs using a commercial ELISA kit. RESULTS: 21.3% of the HCV and 14% of the HBV patients tested positive for IgG anti-CLAbs (P < 0.0001 compared with healthy controls). Neither age, sex, certain epidemiologic and laboratory parameters nor the clinical status and the histologic findings were associated with anti-CLAbs detection in both diseases. 2.3% of the HCV (P < 0.05 compared with healthy controls) and 2% of the HBV patients tested positive for anti-beta2-GPIAbs. Presence of anti-CLAbs was not associated with features of APLS. CONCLUSIONS: A significant proportion of the HCV and HBV patients had detectable IgG anti-CLAbs. However, the anti-CLAbs titres were relatively low, and in most cases seem to be cofactor-independent ('nonpathogenic'). The latter is further supported by the lack of their association with clinical features of APLS. Furthermore, anti-CLAbs appear to be detected irrespective of the demographic, laboratory, clinical and histologic status in both HCV and HBV. However, prospective studies of longer duration may be required in order to address whether anti-CLAbs in patients with chronic viral hepatitis are or are not of clinical importance.     

The role of the elution in antibody investigations

BACKGROUND: The direct antiglobulin test (DAT) commonly detects immunoglobulin G (IgG) molecules or complement fragments on the red blood cell (RBC) surface. If IgG antibodies are present then elution procedures can be performed to identify the specificity of these antibodies. Our reference laboratory performs elutions on the RBCs of those patients who have received cellular blood products in the past 30 days and have either a newly identified positive DAT with anti-IgG or the agglutination strength is increased over a previous DAT and if ordered by a clinician regardless of transfusion history. This study questioned how frequently elutions contributed novel serologic information under our reference laboratory's current policy or whether elutions should be performed in more selective serologic conditions.
STUDY DESIGN AND METHODS: Recipients whose RBCs underwent eluate testing were identified from the blood bank's database and information about the antecedent DAT and antibody detection test and eluate was recorded.
RESULTS: In total 648 eluates were evaluated and 82 of 648 (12.7%) revealed a novel antibody not present in the serum (an informative eluate). In 2 of 82 informative eluates non–anti-A/B alloantibodies that were not present in the serum were detected: one example each of anti-D and anti-E. Both were associated with a microscopically positive antecedent DAT. The rate of an informative eluate was higher when the antibody detection test was negative.
CONCLUSION: The strength of the DAT does not indicate the likelihood of an informative eluate. Performing an eluate when the antibody detection test is positive has limited value.     

Prevalence of hepatitis G virus RNA and antibodies to HGV envelope protein (anti-E2) in patients with liver injury in Japan]

To assess the role of hepatitis G virus (HGV) in acute and chronic liver diseases, we investigated the prevalence of HGV RNA and antibodies to HGV envelope protein (anti-E2) among patients with liver diseases diagnosed in our hospital from 1992 to 1997. Among 24 patients with acute hepatitis (HAV: 13, HBV: 2, HCV: 3, CMV: 1, non A-C: 5), only 1 patient with non A-C hepatitis (4%) were positive for HGV RNA and none was positive for anti-E2. Among 461 patients with chronic liver diseases (alcohol: 27, HBV: 74, HCV: 297, HBV + HCV: 10, non B non C: 14, autoimmune and metabolic: 39), 40 patients (alcohol: 1, HBV: 3, HCV: 33, HBV + HCV: 3) were positive for HGV RNA(9%) and 48 patients were positive for anti-E2(17%). In the patients with positive for anti-E2, only 8% were positive for HGV RNA. 98% of HGV RNA positive patients were infected with HBV or HCV, and especially 82% were infected with HCV. In patients with non A-C hepatitis, none was positive for HGV RNA, so HGV seems not to have important role in liver diseases.     

手术前、分娩前、输血前血源性疾病指标检测对比分析

目的了解手术前、分娩前、输血前患者血源性疾病感染情况。方法调查2005年6月-2006年12月医院术前、分娩前、输血前的HBV、HCV、HIV、梅毒血清标志物检测结果，血清标志物检测采用酶联免疫吸附实验。结果乙型肝炎血清标志物五项检测中HBsAg单项阳性占0．18％，HBsAg阳性合并抗HBe、抗HBc、HBeAg阳性占9．50％，丙肝阳性占2．06％，梅毒阳性占1．03％。结论术前、分娩前，输血前患者血源性疾病感染水平较高，强化检测有助于减少纠纷，增强医护人员防护意识。     

Posttransplant immune-mediated hemolysis

BACKGROUND: Immune-mediated hemolysis is a well-recognized complication of transplantation, but few reports have drawn together the different mechanisms that could be involved. STUDY DESIGN AND METHODS: The clinical and laboratory records of three patients are used to illustrate different types and complexities of posttransplant immune-mediated RBC destruction. RESULTS: Patient 1 received bone marrow from an HLA-matched, unrelated donor. At 7 months after transplant, his Hb level fell to 50 g per L. The serum contained warm autoantibodies, and the DAT was strongly positive for IgG, IgM, and C3d; an eluate yielded IgG and IgM autoantibodies. Autoimmune hemolytic anemia was diagnosed. Patient 2, blood group A, experienced severe hemolysis 14 days after receiving a lung from a group O donor. The DAT was positive for IgG. Serum and RBC eluate contained anti-A produced by immunocompetent B cells in the transplanted lung-this was the passenger lymphocyte syndrome. Patient 3 experienced posttransplant hemolysis caused by two different immune mechanisms. Originally group A, D- with anti-C, -D, -E, she received a peripheral blood progenitor cell (PBPC) transplant from her HLA-identical group A, D+ son. Six months later, chimerism was evident; the remaining recipient marrow was still producing antibodies that destroyed D+ RBCs made by the transplant. Later, autoimmune hemolytic anemia also developed; the DAT became positive for IgG, and warm autoantibodies were eluted from D- RBCs. CONCLUSION: An understanding of the causes and circumstances under which posttransplant immune hemolysis arises is required for proper management. As more patients become long-term survivors of unrelated bone marrow and/or PBPC transplants, chimerism and complex serologic problems will become more common.     

Evaluation of the manual hexadimethrine bromide (Polybrene) technique in the investigation of autoimmune hemolytic anemia

The use of the direct manual hexadimethrine bromide (Polybrene) test (DPT) in the investigation of patients for autoimmune hemolytic anemia (AIHA) was evaluated. Seventy-nine blood samples from 68 patients were tested. A direct antiglobulin test (DAT) using monospecific reagents and the DPT were performed, and a concentrated ether eluate was tested. The DAT was positive in 62 (78%) of 79 patients and negative in 17 (22%). There is a good correlation among DAT, eluate, and DPT in demonstrating the presence of immunoglobulin on the red cell surface. In contrast, the DPT does not detect C3d and is often negative in cases of AIHA in which C3d alone is demonstrated by the DAT. In DAT-negative cases, DPT results correlated with reactive eluates. However, in four cases of steroid-responsive, DAT-negative hemolytic anemia, the DPT supported the diagnosis of AIHA when the eluate did not react. The DPT is a useful additional screening test for the investigation of AIHA, but it is not recommended as a replacement for either eluate testing or the DAT.     

3560例静脉吸毒者HBV或HCV重叠感染HIV状况分析

目的了解静脉吸毒者乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)与艾滋病病毒(HIV)重叠感染状况,探讨两种不同类型肝炎病毒感染与丙氨酸转氨酶(ALT)异常率的关系。方法采用酶联免疫吸附试验(ELISA)法,对1997年1月至2009年8月来自愿戒毒的3560例静脉吸毒者进行血清抗-HIV、抗-HCV、HBV标志物(HBV-M)(以HBsAg阳性作为HBV感染指标)检测。用χ2检验进行统计学分析判断其差异性。结果3560例静脉吸毒者共检出抗-HIV阳性72例,感染率为2.02%。HBV、HCV感染率分别为34.8%(1240/3560)和58.1%(2070/3560),均高于非静脉吸毒者,差异有统计学意义(P0.001)。其中有共用注射器史者HIV、HBV、HCV感染率高于无共用注射器史者,差异有统计学意义(均P0.001)。在两种不同类型肝炎病毒感染者中,HIV/HCV重叠感染率3.43%(71/2070),明显高于HIV/HBV1.29%(16/1240),差异有统计学意义(P0.05)。71例HIV/HCV重叠感染者中ALT增高48例,16例HBV/HIV重叠感染者中ALT增高2例,ALT异常率分别为67.6%(48/71)和12.5%(2/16)二者差异有统计学意义(P0.001)。结论在静脉吸毒者中,HCV/HIV重叠感染概率明显高于HBV/HIV,在静脉吸毒的HCV/HIV重叠感染者中ALT检测尤其重要,对病情观察和HIV的监测有着重要临床意义。抗-HCV阳性者是HIV感染的高危人群,共用注射器吸毒是引起多种病毒重叠感染的主要途径。     

The efficacy of performing red cell elution studies in the pretransfusion testing of patients with positive direct antiglobulin tests

In order to evaluate the efficacy of performing red cell elutions in pretransfusion testing, the serologic records of 638 patients with positive direct antiglobulin tests (DAT) were reviewed. These patients were identified by routine antibody screening procedures that included an autologous control. DAT results on the red cells of these patients showed 279 with IgG and C3d sensitization, 319 with IgG alone, and 40 with C3d sensitization alone. Of 638 patients' red cell eluates, 401 demonstrated no reactivity, 154 demonstrated panagglutination, and 60 demonstrated passively acquired anti-A,B. Only 23 of 638 patients had alloantibody sensitization of their red cells. Of the 23, 19 had serum antibody corresponding to the specificity of antibody detected in the eluate. Thus, only four of 638 (0.6%) eluates gave results unavailable by serum testing alone. This study indicates that routine eluate investigation provides little useful information in assuring compatibility. Serum antibody testing and careful review of the clinical and transfusion history constitute appropriate pretransfusion testing in patients with positive direct antiglobulin tests. Eluate testing should be restricted to cases in which immune hemolysis is suspected clinically.     

Features of combined (HBV/HCV-infection) viral lesion of the liver

AIM: To study clinical, biochemical features, course of combined viral hepatitides, dominant viral activity in combination HBV/HCV infection. MATERIAL AND METHODS: A total of 37 patients with HbsAg and anti-HCV, 23 patients with chronic hepatitis C and 48 patients with chronic hepatitis B were examined (the study and comparison groups, respectively). 67 HbsAg carriers with normal,hepatic parameters (no clinical symptoms, normal transaminase activity) served controls. RESULTS: In patients with parallel detection of HbsAg and anti-HCV detectability of HBV-DNA was 8.1% while HCVrNA was detected in 84% cases. Half the patients with HbeAg positive HBV had seroconversion 1.5-2 years after HCV infection. Documented HCV infection in HBV patients leads to elimination of one of the viruses (HBV more frequently) in more than 50% cases. HCV infection may induce seroconversion of HbeAg. Biochemical parameters (bilirubin, AIAT, AP, gamma HTP of blood) in patients with mixed infection compared with those with mono-infection were 1.5 times higher. In mixed infection cytokines (TNF-alpha, IL-1 beta, IL-6, IL-8, TGF-lbeta) levels were also higher, the diameter of the portal vein was larger (16.9 +/- 0.5 mm). Conclusion. In mixed viral infection there are marked changes in clinico-biochemical, morphological and hemodynamic indices with a clear trend to early formation of portal hypertension with significant alterations in the esophago-gastroduodenal zone.     

Prevalence of human immunodeficiency virus testing in patients with hepatitis B and C infection

OBJECTIVES: To determine the proportion of patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) who are adequately assessed for human immunodeficiency virus (HIV) and to identify variables associated with absence of HIV testing. PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients who had positive serologic test results for reactive HBV and/or HCV between January 1999 and December 1999 and were followed up at a general internal medicine clinic in East Harlem, NY. Data were collected on patient demographics, HIV risk factors, and other variables that might influence the physician's decision to test the patient for HIV. Primary outcomes were HIV tests performed and documented discussions of at-risk HIV behavior. RESULTS: The HIV tests were performed in 40% (95% confidence interval [CI], 32%-49%) of the 141 patients with reactive HBV and/or HCV serologic test results. Predictors of HIV testing on multivariate logistic regression were age younger than 50 years (odds ratio [OR], 25; 95% CI, 13-3.8), male sex (OR, 1.6; 95% CI, 1.1-2.2), and having an established primary care provider (OR, 2.3; 95% CI, 1.2-3.9). Injection drug use was not significantly associated with HIV testing. CONCLUSIONS: Although HBV and HCV have clear epidemiological links with HIV, this study shows that a high percentage of these patients are not being tested. Although some of the factors associated with lack of testing were identified, further studies on the barriers to HIV testing are needed to reveal potential approaches to increase rates of HIV testing in this high-risk population.     

广州地区HIV感染者的临床和流行特征分析

目的：了解人类免疫缺陷病毒(HIV)感染者中HIV感染途径、HIV／HBV及HIV／HCV合并感染情况和机会性感染的发生率及类型。方法：检测HIV感染者／获得性免疫缺陷综合征(AIDS)患者HBV、HCV感染标志，确定HIV／HBV、HIV／HCV合并感染情况，了解其HIV感染途径，对是否存在机会性感染情况进行临床和实验室指标的综合诊断。结果：55例HIV感染者中静脉吸毒、性接触、输血或血制品及垂直传播分别占40％、36．4％、20．0％及3．6％。HIV／HBV、HIV／HCV合并感染率分别为16．4％和41．8％，两者比较有显著差异。机会性感染发生率为85．5％，感染类型由高至低依次为：肺炎、口腔毛状黏膜白斑(OHL)、口腔真菌感染、各种感染性腹泻、各种结核病、败血症、疱疹病毒感染。结论：广州地区HIV感染途径由高到低的顺序为：静脉吸毒传播、性传播、输血或血制品传播、母婴传播，其中以静脉吸毒和性接触方式感染为主。广州地区存在HIV／HBV、HIV／HCV合并感染情况，尤其是HIV／HCV合并感染率情况较严重；来医院住院治疗的HIV感染者绝大部分为已发生机会性感染的AIDS患者。     

Clinical application of a flow cytometric direct antiglobulin test

BACKGROUND: The clinical application of flow cytometric direct antiglobulin test (FC-DAT) has rarely been evaluated for patients with various diseases including immune and nonimmune hemolytic anemia.
STUDY DESIGN AND METHODS: Blood samples from 380 patients with a variety of diseases were studied using the tube direct DAT and FC-DAT. The results of tube DAT and FC-DAT were compared. The predictive values of DAT for hemolysis were evaluated.
RESULTS: Of 57 patients with autoimmune hemolytic anemia (AIHA), 6 of the 17 with a negative tube DAT (immunoglobulin G [IgG]) had a positive FC-DAT (IgG) and 23 of the 36 patients with a negative tube DAT (complement 3d [C3d]) had a positive FC-DAT (C3d). In 57 patients with AIHA, the incidence of positive results of FC-DAT (IgG) and tube DAT (IgG) were similar (42 positive vs. 40 positive); but in 323 patients without AIHA, the incidence of positive FC-DATs (IgG) was higher than that of tube DAT (IgG; 47 positive vs. 9 positive). The higher incidence of positive FC-DAT (C3d) than that of tube DAT (C3d) was seen in patients with AIHA (42 positive vs. 21 positive) as well as in patients without AIHA (61 positive vs. 5 positive). Both DAT (IgG) and DAT (C3d) positive has highest positive predictive value for hemolysis, followed by DAT (IgG) alone positive and DAT (C3d) alone positive.
CONCLUSIONS: FC-DAT is a complementary test for diagnosing AIHA. There is a synergistic effect of the red blood cell–bound IgG and complement in predicting hemolysis.     

RBC autoantibodies in autoimmune lymphoproliferative syndrome

BACKGROUND: Patients with autoimmune lymphoproliferative syndrome (ALPS) have an autosomal dominant genetic defect that affects lymphocyte apoptosis and is associated with chronic nonmalignant lymphadenopathy, splenomegaly, and autoimmunity, particularly affecting RBCs, WBCs, and platelets. STUDY DESIGN AND METHODS: DATs were performed on 34 consecutive patients with ALPS and 37 of their clinically unaffected relatives. The effects of age, sex, race, and immunoglobulin levels on the incidence of autoantibodies and clinical hemolysis were assessed. RESULTS: The DAT was positive in 21 (62%) of ALPS patients but in only 1 (3%) of their relatives (p = 0.001). The DAT reacted because of IgG alone in 43 percent, complement alone in 5 percent, and IgG plus complement in 19 percent; 33 percent of the patients' cells had a positive reaction with polyspecific reagent only. All 10 ALPS patients with a history of hemolytic anemia had a positive DAT. Sixty percent of them had only IgG on their cells, 30 percent had IgG and complement, and 10 percent reacted only with polyspecific reagent. Of the 11 patients with a positive DAT and no history of hemolytic anemia, IgG alone was present in 27 percent, complement alone in 9%, and IgG plus complement in 9 percent; 55 percent had positive DATs only with polyspecific reagent. Among ALPS patients, those with a positive DAT had greater quantities of cells with increased alpha and ss T-cell receptors that phenotyped as CD4-CD8- and higher IgG levels. CONCLUSIONS: The DAT results in ALPS patients are most similar to those found in warm autoimmune hemolytic anemia. The DAT is useful to distinguish affected and unaffected persons within an ALPS family.     

河南省驻马店市“艾滋病病毒单阳”家庭阴性配偶4种性病相关病毒感染调查

目的了解河南省驻马店市艾滋病病毒（HIV）单阳家庭阴性配偶HIV、病毒性乙型肝炎（乙肝）病毒（HBV）、病毒性丙型肝炎病毒（HCV）及梅毒感染现状及合并感染现状。 方法采用普查方法,对河南省驻马店市HIV单阳家庭阴性配偶进行血清流行病学调查,采集阴性配偶的血标本,检测其HIV、HBV、HCV及梅毒感染状况。结果本次调查共采集HIV单阳家庭中HIV抗体阴性配偶血样3619份,经检测HIV抗体阳性49例,HIV感染率为1.35%,抗-HCV感染率为31.20%,且随着年龄的增加而逐步升高（趋势2=-3.78,P0.01）、梅毒感染率为0.17%,但女性感染率高于男性（2=0.0061,P0.01）、乙肝表面抗原（HBsAg）感染率为5.40%、乙肝大三阳［HBsAg、乙肝病毒e抗原(HBeAg)、乙肝病毒核心抗体(抗-HBc)］阳性率为0.77%,乙肝小三阳（HBsAg、抗-Hbe、抗-HBc）阳性率为2.93%。HBsAg/HCV合并感染率最高为1.22%。HIV阳性者中,合并感染人数占的63.27%。结论驻马店市HIV单阳家庭阴性配偶的HIV感染率较高,已成为HIV感染的高危人群之一,4种传染病存在混合感染现象,建议加强对该人群的随访,定期检测HIV、HBV、HCV及梅毒,以控制4种传染病家庭内经性传播。     

浙江省温州市吸毒人员中四种性传播疾病感染状况及影响因素调查

目的 了解浙江省温州市吸毒人员艾滋病病毒(HIV)、乙型病毒性肝炎病毒(HBV)、丙型病毒性肝炎病毒(HCV)以及梅毒螺旋体(TP)感染状况及影响因素,为开展干预工作,预防控制相关疾病在该类人群中流行提供依据。 方法 2011年新入住温州市强制戒毒所戒毒的人员作为本次调查对象进行匿名问卷调查,采集静脉血进行HIV、HBV、HCV、TP血清学检测,并对结果进行统计分析。 结果 403名吸毒人员HIV、HBV、HCV、TP阳性率分别为0.50%、16.87%、55.09%和9.68%。合并HBV/HCV、HBV/TP二重感染分别占60.49%和8.64%,HBV/HCV/TP、HIV/HBV/HCV三重感染分别占27.16%和2.47%,HIV/HBV/HCV/TP四重感染占1.23%。 结论 吸毒人员是HIV、HBV、HCV、TP感染的高危人群,应加强对该类人群的宣传教育和行为干预,以降低这几种疾病在该人群中的传播和扩散。     

Prevalence and risk factors of hepatitis C virus, hepatitis B virus, and human immunodeficiency virus in multiply transfused recipients in Mexico

BACKGROUND: Transfusion-transmitted viral infection (TTI) is a major problem in patients receiving blood products. Monitoring high-risk patients is essential for assessing the epidemiology of blood-borne infections.
STUDY DESIGN AND METHODS: A 1-year, cross-sectional seroprevalence study in patients with a history of multiple transfusions was conducted. Peripheral blood samples were titered to detect serologic markers of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The presence of these viruses and demographic, behavioral, and medical traits were assessed.
RESULTS: A total of 300 male and female multiply transfused patients with a mean age of 30.7 (±17.5) years were studied. The prevalence was 13.7% for HCV, 7% for HBV, and 1.7% for HIV. Patients with hemophilia had the highest prevalence for HCV and HIV infections, and hemodialyzed patients, for HBV infection. The risk factors related to acquired HCV were hemophilia (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.5-12.6), more than five hospitalizations (OR, 3.8; 95% CI, 1.6-8.9), and having received a transfusion before mandatory screening in 1993 (OR, 8.4; 95% CI, 2.0-34.6), and for HIV, having received a transfusion before 1987 (OR, 19.0; 95% CI, 2.0-177.7). The main risk factors for HBV were having end-stage renal disease and being treated with hemodialysis (OR, 3.7; 95% CI, 1.4-9.9) and transplantation (OR, 4.2; 95% CI, 1.4-12.1).
CONCLUSIONS: This study showed that HCV infection was more frequently identified than HBV and HIV infections in multiply transfused Mexican patients. Additionally, several risk factors are associated with TTI such as mandatory screenings before 1987 and 1993, which were the most important for HIV and HCV infections but not for HBV.     

肾移植供受者病毒感染的调查与分析

为了解肾移植供受者肝炎等病毒的感染情况，研究其感染后的护理与肾移植术后人肾存活率的关系。对供受者进行乙型肝炎（HBV）、丙型肝炎（HCV）、庚型肝炎（HGV）及巨细胞病毒（CMV）、EB病毒、单纯疱疹病毒（HSV）、艾滋病病例（HIV）的调查。结果：200例供者中感染HBV16例，感染HCV5例，感染HGV1例，CMV－IgM阳性者31例，EB－IgM阳性者24例，HSV－IgM阳性者36例，HIV病毒携带者1例。210例移植者中HBV感染者136例，HCV感染者74例，HBV、HCV双重感染者49例，HGV感染者14例，HGV、HBV双重感染者14例，HGV、HBV、HCV三重感染者7例，HSV－IgM阳性者86例，无HIV携带者。结论：供受者术前病毒感染状态对移植受者术后是否发生病毒感染至关重要，良好的术前术后护理可降低术后并发症的发生率。