献血员抗HCV筛查效果的再评价

采用 ＥＬＩＳＡ及 ＲＴ－Ｎｅｓｔｅｄ ＰＣＲ对献血员与接受输血治疗者血清 ＨＣＶ感染标志进行了调查。结果表明，在筛选措施开展前献血员抗ＨＣＶ阳性率为１１．５４％，经地方血站筛选后献血员抗ＨＣＶ阳性率可降至２．５５％。同期受血者抗ＨＣＶ阳性率为８．８２％，而８例接受抗ＨＣＶ阳性血液者的血清抗ＨＣＶ与ＨＣＶＲＮＡ阳转比例分别为５／８与６／８。表明抗ＨＣＶ筛查措施在我国输血后丙肝预防中已起到十分重要的作用。进一步研究发现，在３０例抗ＨＣＶ阴性的献血员中，６例（２０％）血清ＨＣＶ ＲＮＡ阳性。３４例抗ＨＣＶ与血浆ＨＣＶ ＲＮＡ均阴性的献血员中 ５例（１４． ７１％）外周血单个核细胞内检出 ＨＣＶ ＲＮＡ。这一结果表明，采用血清抗ＨＣ Ｖ筛选措施不能完全筛除献血员中的ＨＣＶ感染者。部分抗ＨＣＶ阴性献血员血清及外周血单个核细胞中隐藏的 ＨＣＶ可能是抗 ＨＣＶ阴性血液传播ＨＣＶ感染的重要因素。     

聚合酶链反应检测血浆及外周血单个核细胞中HCV—RNA的意义

目的 为提高丙型肝炎病毒ＲＮＡ（ＨＣＶ－ＲＮＡ）的率。方法 采用套式逆转录聚合酶链反应（ＲＴ－ＰＣＲ）技术,检测２００例抗－ＨＣＶ阴性,ＡＬＴ反复异常,临床疑似丙型肝炎患的血浆及外周血单个核细胞（ＰＢＭＣ）中ＨＣＶ－ＲＮＡ。结果 ５２例患血浆中检出ＨＣＶ－ＲＮＡ,阳性率为２６％,７８例患ＰＢＭＣ中检出ＨＣＶ－ＲＮＡ,阳性率为３９％,其中两同时双阳性有２２例,阳性率为１１％。结论 同步检测丙     

丙型肝炎病毒再感染与初次感染对比研究

用套式ＰＣＲ法检测ＨＣＶＲＮＡ，对比研究了ＨＣＶ再感染与初次感染。１０例初次感染ＨＣＶ者，９例为临床型肝炎，１例亚临床型，首次ＡＩ／Ｔ升高距输血的时间为１５～６０天（平均３７．９±１３．９）；抗－ＨＣＶ和ＨＣＶ－ＲＮＡ阳性１年以上分别为１０／１０和７／１０。５例再感染者，４例为临床型肝炎，１例亚临床型，ＡＬＴ首次升高距输血时间为３０～４６天（平均３４．８±６．ｈ），抗－ＨＣＶ和ＨＣＶＲＮＡ阳性１年以上分别为５／５和３／５。结果表明，ＨＣＶ再感染与初次感染在临床表现、ＡＬＴ异常。抗－ＨＣＶ和ＨＣＶＲＮＡ阳性持续时间等均无明显差异，提示ＨＣＶ感染后诱发的免疫力较差，再感染仍可发病。     

输血传播庚型肝炎的前瞻性观察

目的了解庚型肝炎（ＨＧ）在我国输血后肝炎中的发生率及其与输血后乙型肝炎（ＨＢ）、丙型肝炎（ＨＣ）的关系。方法检测１３８例因手术输血病人在输血前后的ＨＢｓＡｇ、抗－ＨＢｓ，ＨＢｅＡｇ、抗－ＨＢｅ、抗－ＨＢｃ、抗－ＨＣＶ、ＨＣＶＲＮＡ和ＨＧＶＲＮＡ。结果５３例发生输血后肝炎病毒感染，其中丙型肝炎病毒感染４８例；乙型肝炎病毒感染２例（含１例两型混合感染）。７例输血后可用巢式ＲＴ－ＰＣＲ法查到庚型肝炎病毒感染，３例合并丙型肝炎病毒感染者均有ＡＬＴ增高。４例单纯ＨＧＶ感染者，ＡＬＴ均正常。ＨＧＶＲＮＡ持续１个月至半年不等。５例输血后ＨＧＶ感染的病人可查到供血，其中３例病人至少有１份供血ＨＧＶＲＮＡ阳性。结论单纯ＨＧＶ感染的献血员和输血后感染者均无病毒性肝炎的临床表现和ＡＬＴ改变，与ＨＧＶ作为一种重要肝炎病毒的观点不相符。     

两种方法检测肝炎患者血清抗—HCV与HCVRNA的比较

丙型肝炎病毒 (ＨＣＶ)过去主要采用ＥＬＩＳＡ法检测血清中的抗 -ＨＣＶ ,但有些早期感染者血清中ＨＣＶ浓度很低 ,无法检测到抗原 (或抗体 )。逆传录—聚合酶链反应 (ＲＴ -ＰＣＲ )是诊断ＨＣＶ感染最敏感、最直接的手段。为探讨肝炎患者抗 -ＨＣＶ与ＨＣＶＲＮＡ的检出关系 ,我们于 1996～ 1998年对 72例不明原因的肝炎患者进行了检测分析 ,报告如下。1　对象与方法1 1　病例来自泰安市中心医院、泰山医学附属医院、新汶矿务局中心医院等收的ＡＬＴ异常、抗 -ＨＡＶＩｇＭ和ＨＢｓＡｇ均阴性的患者 ,其中临床非甲非乙型急性肝炎 (ＡＬＴ…     

河北省固安县北斜村HCV感染者三年随访研究

笔者对４２例抗０ＨＣＶ阳性者进行了三年随访研究，发现血清ＡＬＴ异常者占１８．１％￣２６．２％，ＨＣＶ ＲＮＡ阳性率为８０％。三年间抗－ＨＣＶ年阴转率仅０．９５％，抗－ＨＣＶ抗体几何平均滴度１６０左右，１９９１年１９９４年检测结果表明抗－ＨＣＶ ＧＭＴ值无明显差异，抗体滴度与血清ＡＴＬ水平以及ＨＣＶ ＲＮＡ无关。     

乙、丙型肝炎病毒重叠感染的慢性肝病患者肝组织和血清中的病毒检测

为了探讨乙型和丙型肝炎病毒（ＨＢＶ和ＨＣＶ）重叠感染者病毒相互干扰现象，对４４例患者血清检测诊断为ＨＢＶ和ＨＣＶ感染的慢性肝病患者，用原位杂交法检测了肝组织中ＨＢＶＤＮＡ和ＨＣＶＲＮＡ。２８例患者肝组织ＨＢＶＤＮＡ和ＨＣＶＲＮＡ同时阳性，两者阳性信号分布类型比较无明显差异（Ｐ＞０．０５），血清ＨＢｅＡｇ阳性和阴性组中肝组织中的ＨＢＶＤＮＡ和ＨＣＶＲＮＡ检出率无明显差异（Ｐ＞０．０５）。８例血清ＨＢｓＡｇ阴性者，肝组织ＨＢＶＤＮＡ阳性５例，ＨＣＶＲＮＡ阳性３例。结果提示，ＨＢＶ和ＨＣＶ重叠感染肝组织损伤加重，可能诱导一种病毒呈现潜伏状态，但不是病毒清除。     

抗—HCV阳性血引发感染的核酸证据

血液和血液制品是丙型肝炎的主要传播方式之一,供血者健康检查标准规定凡ＥＬＩＳＡ检测抗ＨＣＶ抗体阳性者均不得献血。但ＥＬＩＳＡ检测存在着漏检及假阳性问题,并且只有ＨＣＶ－ＲＮＡ阳性血清才具有感染性。因此,我们对某血站送检的１００例抗ＨＣＶ阳性献血员的血样进行了ＨＣＶ－ＲＮＡ检测,结果表明,在ＨＣＶ－ＲＮＡ半套式ＲＴ－ＰＣＲ中,传统的异硫氰酸胍／氯仿／异戌醇方法同磁珠法抽提病毒ＲＮＡ,结果两种方法同样可以得到理想的２４０ｂｐ扩增带。用传统方法进行实验,１００例血标本中３例ＨＣＶ－ＲＮＡ阴性,其它均阳性,说明我国制定的献血员标准规定绝大多数情况下是适宜的,如果结合ＲＴ－ＰＣＲ检测ＨＣＶ－ＲＮＡ,结果会更加理想。这为库血ＨＣＶ检测与献血员ＨＣＶ感染检测提供了一种可靠的检测方法,对防止输血后肝炎的发生、净化献血员有一定的指导意义     

乙型、丙型、庚型肝炎病毒多重感染研究

目的探讨庚型肝炎感染患者是否存在双重感染和多重感染。方法应用庚型肝炎病毒（ＨＧＶ）ＮＳ３区逆转录聚合酶链反应技术检测了ＨＧＶ系列稀释的质控血清及ＡｂｂｏｔＧＢＶ－Ｃ参比样品中ＨＧＶＲＮＡ，并对９０例丙型肝炎病毒（ＨＣＶ）ＲＮＡ阳性和１２例乙型肝炎、丙型肝炎双重感染献血员进行了ＨＧＶＲＮＡ的检测。结果ＨＧＶ系列稀释质控血清１０－１～１０－５均为阳性；１０－６为阴性。２份ＡｂｂｏｔＧＢＶ－Ｃ样品均为ＨＧＶＲＮＡ阳性。９０例ＨＣＶＲＮＡ阳性样品中，８例ＨＧＶＲＮＡ阳性（１７．８％）；１２例乙、丙双重感染者中４例（４／１２）ＨＧＶＲＮＡ阳性。结论不仅存在ＨＣＶ及ＨＧＶ双重感染，也存在多重感染。     

434名HBsAg阴性应招飞行学员中的HCV感染调查

为了解ＨＢｓＡｇ阴性应招飞行学员中的ＨＣＶ感染情况，对体检合格的４３４名ＨＢｓＡｇ阴性健康应招飞行学员用ＥＬＩＳＡ法检测血清中的抗－ＨＣＶ，对抗－ＨＣＶ阳性血清用套式ＰＣＲ法检测了ＨＣＶ ＲＮＡ。结果发现，抗－ＨＣＶ阳性率为０．４６％（２／４３４），在２例抗－ＨＣＶ阳性者中，１例ＨＣＶ ＲＮＡ阳性。提示，为防止慢性ＨＣＶ感染者进入航校，对入学前的飞行学员进行抗－ＨＣＶ检测是必要的。     

腹膜透析患者HCV感染标志检测及临床意义

目的：评价维持性腹膜透析（腹透）患丙丙型肝炎病毒（HCV0感染状况及其临床意义。方法：采用第二代酶链免疫吸附试验（ELISA2）和逆转录聚合酶链反应（RT－PCR）检测60例腹透患者血清抗－HCV和HCVRNA,按HCV标志阳性与阴性分组比较有关临床因素。结果：60例患者中,抗－HVCIgM阳性7例（11．7％）,抗－HCVIgG阳性10例（16．7％）,HCVRNA阳性13例（21．7％）,三项中任一项阳性15例（25．0％）;阳笥组与阴性组相比,两组在性别、年龄、肾功能、HBV标志、EPO（促红细胞生成素）应用上无明显差异,而在平均透时间、输血史、ALT异常、血液透析史、肾移植史方面有显著性差异。结论：腹透患者中HCV感染较为严重,输血为腹透患者感染HCDV的主要途径,但也存在与透析环境有关的传播的可能。     

Prevalence of antibodies to hepatitis C virus in hemodialysis patients and renal transplant recipients

This work was carried out to study the prevalence of hepatitis C virus (HCV) infection, its associated risk factors and possible routes of transmission in hemodialysis patients and renal transplant recipients. Ninety five patients and 15 normal controls were included in this study. Patients were classified into 3 groups: Group I (64 hemodialysis patients), Group II (16 renal transplant recipients) and Group III (15 patients with chronic renal insufficiency on conservative treatments). Each individual was subjected to full clinical examination, estimation of serum alanine aminotransferase (ALT), testing for antibodies to hepatitis C virus (anti-HCV), screening for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B surface antigen (anti-HBs) and core antigen (anti-HBc) by modified ELISA technique. Anti-HCV was found in 87.5% of hemodialysis patients, 81.25% of renal transplant patients, 53.3% of the conservative group and in 13.3% of the control group. There was a significant correlation between the presence of anti-HCV and the duration on dialysis in groups I and II (p < 0.05), while no significant correlation was detected between HCV positive cases and the number of units of transfused blood in groups I and II (p > 0.05). Serum ALT was elevated in patients with HCV infection, but there was no significant correlation between the presence of anti-HCV and elevated ALT level among the examined groups of patients (p > 0.05). The prevalence of HCV infection was not correlated with the duration of renal transplantation and the type of immunosuppressive therapy (p > 0.05). Coinfection with HBV and HCV could occur, as previous infection with HBV was demonstrated. Anti-HBc was found in 51.8%, 66.7%, 37.5% of anti-HCV positive patients in groups I, II, II respectively. Anti-HBs was detected in 24.1% and 15.4% of anti-HCV positive in groups I and II. HBsAg was found only in 4.7% of anti-HCV positive hemodialysis.     

维持性血液透析患者庚型肝炎病毒感染的研究

目的 了解血液透析患者庚型肝炎病毒(HGV)感染情况，探讨其危险因素。方法 采用酶联免疫法(ELISA)和逆转录—套式PCR法分别检测44例血透患者的抗—HGV抗体和HGVRNA。结果 血透患者HGV感染率为13．6％，HGV阳性组与阴性组相比输血次数较多、透析时间较长，但差异无显著性；而单独HGV阳性组与全阴性组相比透析时间明显延长，HGV感染与年龄、HBV感染、HCV感染及肝功能损害无显著相关。结论 血透患者HGV感染率明显高于普通人群，严格消毒措施、预防交叉感染、减少输血、血源中HGV筛查，对减少透析中庚型肝炎病毒感染至关重要。     

血液透析肾病患者GBV-C感染的分析

目的 探讨血液透析病人中GBV-C(GBV-C／HGV)感染情况及GBV-C的致病性。方法 对北京地区67例因肾功能衰竭而进行血液透析的患血清，用PCR法检测HCVRNA，GBV-C RNA和HBV DNA。同时应用ELISA法检测HBsAg和抗-HCV。结果 67例患血清GBV-C RNA的检出率为16．42％。HBV DNA的检出率为26．87％，HCV RNA的检出率为22．39％，GBV-C和HCV的感染率随透析次数的增多而增高。在单独感染GBV-C的血液透析患中未发现血清ALT或AST异常。结论 GBV-C的感染率随透析时间的延长而增高，提示血液透析可能是GBV-C的传播途径之一。未发现经血液透析获得单独GBV-C感染的血清转氨酶异常．证明GBV-C很可能不具有嗜肝致病性。     

献血感染丙型肝炎人群转归分析

目的研究献血感染丙型肝炎病毒（HCV）人群16年后的转归。方法对该人群问卷收集一般情况,肝脏B超检查;采集5ml静脉血,进行丙型肝炎病毒抗体、RNA、谷丙转氨酶（ALT）和血清生化指标（透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原）检测。结果162名研究对象尚未出现晚期肝病患者。抗-HCV阳性率95.68%,RNA阳性率77.78%,ALT异常率20.37%。不同急性期症状感染者,16年后抗-HCV阳性率、ALT异常率和RNA阳性率差异无统计学意义。经性别分层分析,女性感染年龄〉40岁抗体较易阴转（χMH^2=8.26,P=0.04）。结论HCV感染16年后,不同急性期症状感染者转归无差异,病毒清除与性别和初始感染年龄有关。     

降低输血后HCV感染的临床研究

目的：探讨输血后ＨＣＶ感染高发的原因并提出降低发生率的可行措施。方法：对１３８例定期筛检供血及６８例献血前筛检供血的受血者进行了前瞻性调查。用定量ＰＣＲ试剂盒,通过荧光检测仪对１０份供血进行ＨＣＶ ＲＮＡ定量分析;对４１例血清进行ＨＣＶ ＲＮＡ定量、ＡＬＴ用抗－ＨＣＶ检测;用ＲＴ－ＰＣＲ法对３４份抗－ＨＣＶ（－）供血作ＨＣＶ ＲＮＡ定性分析。结果：两种方法筛检供血所致的输血后ＨＣＶ感染率分别为３４     

Detection of HGV in serum and peripheral blood mononuclear cells of maintenance haemodialysis patients.

The aim of the present study was to investigate the prevalence of hepatitis G virus (HGV) and also hepatitis C virus (HCV) infections in maintenance haemodialysis patients, and to identify extrahepatic sites as HGV reservoirs. HGV RNA was detected in the serum of 6/61 (10%) patients and in the peripheral blood mononuclear cells of 2/61 (3%) patients (one of whom was serum negative). These findings suggest that lymphoid cells constitute an extrahepatic HGV reservoir. HCV RNA was detected in 7/61 (11%) patients. Five of these patients (71%) were identified as carrying HCV genotype 1b. Co-infection with HCV and HGV was detected only in one patient. Haemodialysis patients are at risk for HGV infection, by nosocomial routes or via transfusions. HGV itself does not seem to be an important cause of hepatitis since all six HGV RNA positive patients not co-infected by HCV or HBV showed normal ALT values.     

Examination of hepatitis c virus antibody seropositive blood donors and their relatives

INTRODUCTION: 239 anti-HCV seropositive blood donors (132 male, 107 female, age: 19-61, mean: 40.59 y.) and 174 family members of them (74 male, 100 female, age: 4-65, mean: 23.67 y.) were studied for chronic hepatitis C virus infection and chronic liver disease. Detailed virus serology, ultrasonography, and 6 months follow-up and--in patients with HCV RNA--liver biopsy were made. RESULTS: HCV RNA was determined in 165 patients. 70% of them were HCV RNA positive. The ALT level was normal in 95 cases (57%), and lower, than twice of the normal was in 34 cases (20%) among them. Liver biopsy was made in 79 patients; chronic C hepatitis was proven in 75 cases (steatosis in 3 cases, alcoholic liver disease in 1 case was observed). Inflammatory activity was minimal (HAI < 3) in 17, mild (HAI: 3-6) in 41, moderate (HAI: 7-9) in 7, and severe (HAI > 9) in 10 cases. There was no correlation between the serum ALT levels and the severity of the histological activity of chronic C hepatitis. Authors stress the importance of the fact, that 2 patients had normal ALT and 5 patients ALT levels were lower, than the twice of the normal of the 17 patients with significant inflammatory activity (HAI < 6). Chronic C hepatitis need for antiviral therapy was occurred in 45% of patients who known themselves previously healthy. CONCLUSIONS: The necessity of the systematic examination of anti-HCV seropositive patients and of the importance of the liver biopsy in patients with HCV RNA positivity is stressed. 3 anti-HCV seropositive cases of 174 family members of the blood donors were observed, but none of them was HCV RNA positive. It seems to be, family members of the HCV infected patients have no increased risk for HCV infection.     

血液透析患者丙型肝炎病毒感染的预防

目的 调查血透患者丙肝病毒(HCV)感染情况及影响因素，探讨预防HCV感染的措施。方法 在未采取HCV感染预防措施的1990—1992年间、采取HCV感染预防措施的1997—1999年间及使用一次性透析器后的2001—2002年间，采用日本Kuraray公司提供的抗HCV—14试剂盒，以间接酶免疫测定法检测长期维持性血透患者抗体。结果 HCV的1年阳转率1991—1992年为42．2％，1998—1999年为22．8％，2001年--2002年为9％；输血量越多，透析时间越长，丙肝的感染率越高。结论 多次输血是血透患者高丙肝病毒感染的主要原因，透析过程中的医院感染也是不容忽视的重要因素。减少输血量，加强对血透患者HCV感染者的管理，严格消毒隔离，透析器一次使用等可有效控制血液透析(HD)患者高HCV感染状态。