Post-transfusion hepatitis C in Finland

Summary. Six of 11 (55%) non-A, non-B hepatitis (NANBH) patients seroconverted to hepatitis C virus antibody (anti-HCV) positivity 8–16 weeks after transfusions in a prospective post-transfusion hepatitis study on 685 open-heart surgery patients in Finland. Five of them had a seropositive donor, and two of the five non-converted NANBH patients had received an anti-HCV positive unit. Among 36 studied donors who were positive in the anti-HCV ELISA, reactivity of both the antigen bands in a recombinant immunoblot assay (RIBA) for anti-HCV was significantly associated with NANBH ( P < 0·00005) in the recipient. In addition, infective anti-HCV positive donors had raised ALT values more often than seropositive donors which caused no seroconversion or infection in the recipients ( P = 0·0001).     

Antibodies to Hepatitis C Virus and Chronic Liver Disease among Finnish Patients with Haemophilia

Antibodies to hepatitis C virus, hepatitis B serology and liver enzymes were examined in 137 Finnish haemophiliac patients to detect signs of chronic viral hepatitis and its possible aetiological associations. The prevalence of raised alanine aminotransferase values was 37%. These were significantly associated with hepatitis C seropositivity but not with hepatitis B antibodies, severity of haemophilia or the type of clotting factor used in replacement therapy. The prevalence of hepatitis C seropositivity was 50%; it was significantly associated with severe haemophilia and with the use of large pool concentrates. The hepatitis C virus seems to be the major cause of chronic liver disease transmitted by clotting factors also in Finland, despite a somewhat lower seroprevalence than described elsewhere so far.     

输血后HCV感染的前瞻性研究

目的：了解上海地区医院内输血后丙型肝炎病毒（HCV）感染的现状，以制定相应的防治策略。方法：对输血的本院内、外科住院病人采用前瞻性调查。结果：输血后HCV感染率可高达8．48％，而同期住院未输血的对照组未发现HCV感染，而且HCV感染率随输血量增加而呈上升趋势；加强输血前筛查的方法可使感染率降至2．1％左右。结论：在尚无丙型肝炎疫苗的情况下，提倡义务献血和加强对血源的筛查是控制输血后肝炎的有效和必要的措施。     

Post-transfusion hepatitis after open-heart surgery in Finland—a prospective study

Summary. A countrywide prospective study on open-heart surgery patients was performed between 1987 and 1989 to determine the prevalence and nature of post-transfusion hepatitis in Finland. Altogether 685 coronary by-pass operation patients, who received on average 12·3 units of blood products, were postoperatively followed for 6 months. Ten blood samples were drawn from each patient. Hepatitis was diagnosed when the alanine aminotransferase values exceeded the upper normal value 2·5 times in one sample and twice in another, and non-viral causes could reasonably be excluded. Eleven hepatitis cases (1·6%) were recorded with a mean incubation period of 8·4 weeks; all represented the non-A, non-B type. The majority had mild symptoms or were asymptomatic but two became icteric. Six patients (55%) had abnormal alanine aminotransferase values for at least 6 months, which indicates possible chronicity. These 685 open-heart surgery patients received a total of 8,436 units of blood products; thus the rate of NANBH cases per 1000 units was as low as 1·3. This is less than recently reported in six other prospective studies.     

140例成人人类免疫缺陷病毒感染与丙型肝炎病毒感染相互影响

目的 了解经输血或单采浆献血感染人类免疫缺陷病毒(HIV)的患者中丙型肝炎病毒(HCV)的感染率；分析HIV与HCV感染的相互影响。方法 对140例经输血或单采浆献血感染HIV的患者血清抗HCV、HBV—M、肝脏生化功能、CD4^ 和CD8^ 细胞计数、纤维胃镜、肝胆脾B超进行分析。结果 140例HIV感染和获得性免疫缺陷综合征(AIDS)患者中HCV抗体阳性者占91．5％(128／140)；HIV和HCV混合感染者肝功能损害较轻，与单纯HIV感染者比较，其肝功能、B超改变、CD4^ 细胞计数之间差异无统计学意义。结论 经输血或单采浆献血感染的HIV感染者中存在着极高的HCV感染(91．5％)。HIV和HCV混合感染者与单纯HIV感染者比较，肝功能损伤并不严重，提示HIV可能并不加速丙型肝炎的进展。     

Predictive markers for hepatitis C antibody ELISA specificity in Australian blood donors

The hepatitis C antibody reactivity rate in 91,748 blood donors tested using the ORTHO HCV C-100 ELISA system was 0.51%. Specificity of ELISA positive reactions was measured using a recombinant immunoblot assay (RIBA). The aim of this study was to identify markers in ELISA positive donors which were predictive of a RIBA positive result. Samples from 430 ELISA positive donors were tested by the first generation RIBA, RIBA-1, which incorporates two HCV peptides C-100 and 5-1-1. Fifty-five per cent (236) were positive and 19% (83) indeterminate. Multivariate analysis of gender, age, HCV ELISA OD ratio, alanine aminotransferase (ALT) status and hepatitis B core antibody (anti-HBc) status identified age, magnitude of HCV ELISA OD ratio and anti-HBc status as the only independent predictors of a positive RIBA-1 result. The relative odds of being RIBA-1 positive were 4.6-fold (95% CI 1.3-16.4) higher among donors aged 25-34 years compared with donors less than 25 or greater than 44; 6.1-fold (2.1-17.9) higher if the donor was anti-HBc positive and 273.4-fold (30.9-2417) higher if the HCV ELISA OD ratio was greater than 5.98 compared to those with a ratio less than 1.77. Seventy-eight of the 83 RIBA-1 indeterminates were tested on the second generation RIBA, RIBA-2, which includes two additional HCV peptide, C22 and C33c. Thirty-one per cent (24) were positive and 41% (32) were negative.(ABSTRACT TRUNCATED AT 250 WORDS)     

拔牙术中乙型、丙型肝炎病毒污染的调查及对策

目的对常规拔牙术中乙型、丙型肝炎病毒污染情况进行调查,进一步控制医源性感染。方法随机抽取500例门诊拔牙患者的术中止血棉球,分别浸入2个（A、B）盛有1ml生理盐水的无菌试管内,其浸出液分别用两种方法进行肝炎病毒检测。结果A组（HBsAg）检测到40例阳性（8．00％）,B组（IgG）检测到12例阳性（2．40％）,HBsAg和IgG检测到A组和B组同时阳性2例（0．40％）;500例门诊拔牙患者中检测到被肝炎病毒感染的有54例,占调查总人数的10．8％。结论口腔门诊乙型、丙型肝炎感染率很高,迫切要求口腔医务工作者要加强职业防护,有效防治肝炎病毒通过口腔科诊疗传播。     

A prospective study of the risk of transfusion-acquired viral infections

The risk of transfusion-transmitted viral infections may be estimated by several methods, but only prospective studies of transfusion recipients can directly measure the incidence, with associated 95% upper confidence bound, of these infections. From 1989 through 1995, 764 recipients of allogeneic or autologous red blood cell transfusions were enrolled; 486 (64%) provided both pretransfusion and 6-month follow-up specimens. Both specimens were tested for anti-HBc, anti-HCV, anti-HTLV-I and anti-HIV, with appropriate confirmatory testing. Thirty-nine (8.0%) subjects had seroprevalent anti-HBc, 19 (3.9%) subjects had seroprevalent anti-HCV, three (0.6%) subjects had seroprevalent anti-HTLV-I/II, and one (0.2%) subject had seroprevalent anti-HIV. There were no seroconversions for any agent among the 34 patients who received only autologous blood, and no confirmed seroconversions for anti-HTLV-I or anti-HIV among all subjects. There were three seroconversions for anti-HBc (incidence 1.04 × 10^?3; 95% confidence interval (CI) 2.15 × 10^?4, 3.05 × 10^?3 per allogeneic unit transfused), and two confirmed seroconversions for HCV (incidence 6.94 × 10^?4; 95% CI 8.34 × 10^?5, 2.51 × 10^?3 per allogeneic unit transfused). One of the two anti-HCV seroconversions occurred in March 1994, after the institution of HCV EIA 2.0 screening of donated blood. Transfusion-associated seroconversions to hepatitis B and C markers were observed at low rates in the early 1990s despite testing donors for markers of both viruses, whereas seroconversions to HTLV-I or HIV were less than 1.04 × 10³ per allogeneic unit transfused, based upon the upper 95% confidence interval of the zero incidence in this study.     

HCV-IgG、HCV-cAg与HCV-RNA对丙型肝炎诊断的评价

目的评价丙型肝炎病毒核心抗原(HCV-cAg)、丙型肝炎病毒抗体(HCV-IgG)及丙型肝炎病毒RNA(HCV-RNA)3种检测方法在丙型肝炎实验室诊断中的意义。方法收集84例丙型肝炎疑似患者和87例健康对照者血清,采用ELISA法检测HCV-cAg和HCV-IgG,实时荧光定量聚合酶链式反应法(RT-PCR)检测HCV-RNA。结果 84例丙型肝炎疑似患者中HCVIgG阳性率为84.5%,HCV-cAg阳性率为13.1%,HCV-RNA阳性率为52.4%;71例HCV-IgG阳性患者中HCV-RNA阴性35例,假阳性率为49.3%,11例HCV-cAg阳性患者中HCV-RNA阴性5例,假阳性率为45.5%;44例HCV-RNA阳性的丙型肝炎确诊患者中HCV-IgG假阴性率为18.2%,HCV-cAg假阴性率为86.4%;HCV-cAg和HCV-IgG联合检测的假阴性率为13.6%,真阳性率为100.0%。结论 HCV-cAg和HCV-IgG在丙型肝炎的实验室诊断中均存在一定的假阴性和假阳性,将二者联合检测或在必要时与HCV-RNA三者联合检测可降低漏诊率。     

Frequency and characteristics of post-transfusion hepatitis in Greece with emphasis on hepatitis C: comparing second- and third-generation assays

SUMMARY. In order to evaluate the role of hepatitis C virus (HCV) in post-transfusion hepatitis (PTH) in Greece we prospectively followed 143 transfusion recipients, receiving 790 units of blood and/or products from 789 donors, between October 1989 and December 1991. The mean number of units transfused per patient was 5–52. PTH was observed in 18 patients (12–59%). One patient (0–70%) developed hepatitis B, in four (2–80%) hepatitis could be attributed to CMV infection, 10 (6–99%) developed hepatitis C and three (2–10%) showed only raised alanine aminotransferase (ALT) levels. The risk of PTH per 1000 units transfused was 22–8. The patient who developed hepatitis B (PTH-B) was transfused with four units, one of which was positive for anti-HBc and anti-HBe. Seven of the 10 patients (70%) who developed hepatitis C (PTH-C) were transfused with at least one unit seropositive in the anti-HCV screening with 2nd-generation tests (ELISA-2 and RIBA-2), whereas 9/10 of PTH-C cases (90%) were transfused with at least one unit positive in 3rd-generation assays. Of the three patients who showed only ALT elevation, none was transfused with anti-HCV seropositive blood, although one of them was transfused with at least one unit with elevated ALT levels. We conclude that: (1) the incidence of PTH in Greece remains high, (2)screening of all donations for anti-HCV with an ELISA-2 does not exclude transmission of HCV and (3) ELISA-3 and RIBA-3 seem to be more sensitive in blood donor screening and in detecting seroconversions than ELISA-2 and RIBA-2.     

Retrospective follow-up of recipients and donors of blood donations reactive for anti-HBc or for single HCV antibodies

A retrospective study was undertaken to investigate the infectivity of blood donations that were HCV RIBA indeterminate or reactive for 'anti-HBc only'. Samples from 6032 blood donations were tested for anti-HBc; 17 of them were positive for anti-HBc but were negative when tested for anti-HBs. None of the recipients of the red cells from these donations, when tested 9 months after transfusion, had evidence of HBV infection. Samples from 3000 blood donations were tested for HCV antibodies using RIBA-3; 53 had single lines. Samples taken 9 months after transfusion from the recipients of the red cells from these donations were tested for evidence of infection with hepatitis C, and all were negative.     

Risk of hepatitis C in patients who received blood from donors subsequently shown to be carriers of hepatitis C virus

SUMMARY. A retrospective study was undertaken to identify recipients of blood from donors subsequently shown to be positive for hepatitis C virus using second-generation tests and polymerase chain reaction. The main aims were to determine the numbers of such recipients who were still alive and traceable, and to determine the risk of infection in this group. The feasibility and workload of this procedure, which is currently not practised in the U.K. or U.S.A., was also assessed.
In the first six months of routine testing 42,697 donors were tested. Of 20 confirmed to be HCV-positive, 15 were regular donors. Eighty-three components were prepared from 63 anti-HCV positive previous donations from these donors. In all, nine recipients were found to be alive. All were positive for anti-HCV. We conclude that although this retrospective procedure is time-consuming and difficult, substantial numbers of infected recipients can be identified. The availability of treatment for chronic hepatitis C for such patients should encourage transfusion services to reassess current policies on the hepatitis C retrospective.     

慢性乙型肝炎患者外周血淋巴细胞亚群的变化

目的探讨慢性乙型肝炎（chronichepatitisB,CHB）患者外周血淋巴细胞频率变化。方法利用流式细胞术检测25例正常对照者、28例慢性无症状乙肝病毒携带者（chronicasymptomaticHBVcarrier,ASC）和72例CHB患者外周血T细胞、NK细胞、CD3＋CDl6＋CD56＋NKT细胞和B细胞的频率。结果与对照组和ASC组比较,CHB患者CD4＋T细胞、NK细胞、CD3＋CDl6＋CD56＋NKT细胞频率和CD4／CD8比值减低（P〈O．05,〈O．05,〈o．01,〈O．01）,而CD8＋T细胞频率增高（P〈O．01）,CD3＋T细胞和B细胞频率组间差异无统计学意义（P均〉0．05）。结论CHB患者存在T细胞亚群、NK细胞和CD3＋CDl6＋CD56＋NKT细胞比例失衡,纠正CHB患者细胞免疫紊乱非常重要。     

丙型肝炎病毒感染者自身抗体的检测及临床研究

目的 检测丙型肝炎患者血清肝特异性自身抗体并分析其临床意义。方法 采用间接免疫荧光法，对220例丙型肝炎病毒感染者血清进行肝特异性自身抗体的检测；应用聚合酶链反应定量检测血清HCV-RNA含量，HCV抗体的检测用ELISA法；结果 220例丙型肝炎患者总自身抗体检出率为34．55％；单纯Ant-HCV阳性的检出率为29．57％；HCVRNA和Ant-HCV均阳性自身抗体检出率为40．59％，单纯Ant-HCV阳性与HCV-RNA和Ant-HCV均阳性组比较差异显著（P〈0．01）。各组与正常对照比较差异均非常显著（P〈0．01）；自身抗体以低滴度为主，主要为抗核抗体。自身抗体阳性的检出与性别无关（P〉0．05）而与年龄关系密切（P〈0．01），且自身抗体随年龄的增加检出率升高。结论 HCV感染可诱导自身免疫反应，使患者血清中出现多种自身抗体，检测其自身抗体及滴度对丙型肝炎患者的诊断和治疗有一定的参考价值。     

规律性血液透析患者丙型肝炎病毒感染的研究

目的探讨感染丙型肝炎（HCV）与血液透析（HD）、输血的关系及临床指导意义。方法用ELISA和PCR法检测128例血液透析患者血清中抗HCV和HCV-RNA。结果HD丙型肝炎病毒感染明显高于对照组（P〈0．01）,HD输血组明显高于非输血组（P〈0．01）,而HD输血组与非输血组,乙型肝炎病毒感染差异无显著性（P〉0．05）。结论血液透析（HD）易感染丙型肝炎病毒,输血是引起HD患者丙型肝炎病毒感染的最主要原因。接受异体输血的次数和输血量越多,感染的机率越大,阳性检出率则越高。     

Risk of hepatitis C infection in neonates transfused with blood from donors infected with hepatitis C

This look-back study was undertaken to identify newborn infants who had been infected with the hepatitis C virus (HCV) as a result of transfusions received before the introduction of routine screening in 1991 and to determine the transmission rates and persistence of transfusion-transmitted HCV infection acquired in the neonatal period. A total of 24 infants, transfused between 1980 and 1991, were identified as having received potentially infected blood from 11 blood donors. Ten of the donors had been administered batches of anti-D in 1977 known to have transmitted HCV genotype 1b infection. HCV RNA was detected in five of these donors when tested in 1994–95; the past donations of five of the donors, who had received anti-D immunoglobulin and had serological evidence of previous HCV infection but who were PCR negative when tested in 1994–95, were considered of lower risk. The source and time of acquisition of HCV infection for the one remaining donor in the study was not determined. Twenty-one (88%) of the 24 children were living at time of lookback. The median age at transfusion was 12 days. The median age at time of testing was 6.3 years. One child, who tested negative, was excluded from further analysis of HCV transmission, due to incomplete transfusion records. Overall, 12 of 20 (60%) children tested were positive for anti-HCV and seven (35%) were HCV RNA positive. Twelve (71%) of the 17 recipients of viraemic blood were ELISA positive and seven (41%) were PCR positive. Resolved HCV infection, as determined by ELISA pos, RIBA pos or indeterminate and PCR negativity, occurred in five of 12 (42%). In many instances there was more than one recipient per HCV infected donation. All of the reported children are clinically asymptomatic. However, the duration of HCV infection is relatively short and there is evidence of a degree of hepatitis in five of the seven children who are HCV RNA positive as judged by mildly elevated transaminase levels. The three who have undergone liver biopsy show mild hepatitis. The lower rates of persistence of HCV infection in this study may be due to the young age at exposure or to the source of infection which for all but one of the children was linked to one HCV genotype from female donors. Sharing of units of blood among multiple infants should be discouraged.     

拟输血患者输血前血液传染性指标检测结果分析

目的对拟输血患者在输血前进行血液传染性指标检测,分析相关性传染病感染情况,以减少和避免因输血引起的医疗纠纷以及医务人员的职业感染。方法对2007年1月至2010年9月32 418例拟输血患者采用酶联免疫吸附试验(ELISA)进行乙型肝炎表面抗原(HBsAg)和人类免疫缺陷病毒抗体(抗-HIV1/2)的检测,采用胶体金方法对丙型肝炎病毒抗体(抗-HCV)以及梅毒抗体(抗-TP)进行检测。结果在接受检查的患者中共查出阳性标本4 863例(15.0%),其中HBsAg阳性4 460例(13.9%),抗-HCV阳性265例(0.82%),抗-TP阳性401例(1.24%),抗-HIV阳性67例(0.21%)。在HIV阳性标本中出现不同程度的重叠感染情况,并以HCV的重叠感染率最高。另外抗-TP阳性率呈现逐年大幅上升趁势,而且感染人群中大部分为40岁以上中老年人。结论输血前进行血液传染性标志物检测对减少医疗纠纷及加强医务人员自我保护意识,降低职业暴露危险有重要意义。     

乙型肝炎病毒基因分型与临床的相关性探讨

目的探讨本地区乙肝病毒基因型的分布状况及其与临床病情的相关性。方法收集无抗病毒治疗史的慢性乙型肝炎病人、慢性重型肝炎病人、拉米夫定治疗48周末达有效者、YMDD变异阳性的慢性乙型肝炎病人以及1896位点变异阳性的慢性乙肝病人共120例,采用微板核酸杂交法(PCR ELISA)技术进行HBV-DNA基因分型,比较各组基因型分布特点和不同基因型的临床资料。结果 120例病人中B型22．5％,C型65．8％,BC混合型10．0％;慢性重型肝炎组(B 组)与慢性肝炎轻中度组(A组)相比BC混合型明显增多,以C型及BC混合型为主,并显示统计学差异;拉米夫定治疗48周末达有效人群中(C组)B型比例较高,而1896位点变异组(E组)则显示C型比例更高,但与A组相比基因型的分布并未提示统计学差异。B、C基因型间病毒载量相似,C基因型病人血清转氨酶高于B基因型,差异有统计学意义(P<0．05)。结论本地区乙肝病毒绝大多数为B型和C型,且以C型为主;C型和BC混合型可能与乙型肝炎肝组织损害加重有关;拉米夫定疗效、YMDD变异以及1896变异与HBV基因型之间未显示必然的联系。