单采浆还输血球献血员中丙型肝炎病毒感染的流行病学和血清学研究

本文报告单采浆献血员中丙型肝炎病毒(HCV)感染的流行病学和血清学研究结果。通过对5个自然村3 496人流行病学调查表明,单采浆献血员肝炎现患率和单项ALT异常率分别为17.10%和23.23%,二者均显著高于全血献血员和非献血员成人。经排除法证明,上述肝炎患者绝大多数为肠道外传播的非甲非乙型肝炎。后将部分单采浆献血员肝炎病例和单项ALT异常者的血清标本,送美国疾病控制中心检测,抗-HCV阳性率分别为97.06%和100%。证实为HCV感染。流行病学调查表明,单采浆献血员HC流行是由单采浆还输血球过程中交叉感染引起的。     

合格献血员丙型肝炎病毒感染的非条件Logistic回归分析

本文报告了对410名合格献血员丙型肝炎病毒(HCV)感染及其危险因素的调查结果。结果表明丙型肝炎病毒抗体(抗-HCV)阳性率为23.9%,证明献血员是HCV 感染的高危人群之一。用非条件Logistic 回归分析的结果表明,男性献血员HCV 感染的危险性高子女性(OR=1.73),在单采浆还输血球血站献血者其HCV 感染的危险性高于在全血血站献血(OR=4.51),有ALT 异常史的献血员抗-HCV阳性率高于无ALT 异常史者(OR=2.48)。结果提示,由于目前血站尚未开展抗-HCV 筛检,供血员的血液给受血者造成了感染丙型肝炎的威胁。     

河南省311例成年人群血清中抗HCV的检测

我们应用日本KURARAY公司生产的酶标抗HCV诊断试剂(AR—14多肽抗原包被的微孔塑料条),对实验室冻存的188份体检血清和193份献血员血清进行了检测,结果:188份成年人群抗HCV阳性率为13.29％;献血员抗HCV阳性率为30.08％。为验证上述结果,又用国产上海科华试剂对所有抗HCV阳性和部分阴性血清进行复测,二者符合率为84.1％。初步结果提示:在我省成年人群特别在献血员中丙型肝炎病毒的感染率相当高,应引起有关部门的重视。     

广东地区献血员中抗HCV的调查

本文首次采用ELISA法检测了广东地区202例献血员血清中抗HCV的阳性率,其中谷丙转氨酶正常的健康献血员127名,抗HCV阳性2名,阳性率为1.57％;谷丙转氨酶异常的献血员75名,抗HCV阳性8名,阳性率为10.6％,该研究对于献血员丙型肝炎筛选有一定指导意义。     

对献血员抗-HCV的监测结果分析

报告在二年监测的203份献血员血清标本中检出抗-HCV阳性46份,阳性率为22．7％。经流行病学调查发现:单纯献全血的献血员HCV感染率为6.2％,而在献全血的同时曾参与献血浆者HCV感染率高达75.0％（P＜0．01）。提示单采血浆返还血球更易感染HCV。单项ALT异常者抗-HCV阳性格出率为42.9％．献血员HCV年感染率为10．2％,抗-HCV阳性献血员自然年阴转率为7．7％。     

丙胺酸转氨酶升高者肝炎病毒的病原学调查

为了解在丙胺酶转氨酶（ALT）升高者中甲、乙、丙型肝炎病毒感染情况，用ELISA法对ALT升高血清进行检测。结果：抗－HAV IgM,HBsAg,抗－HCV的阳性率分别为7．8％、14．3％、3．2％；抗－HAV IgM阳性率随ALT值的升高而增加；HBV、HCV混合感染发生率为0．6％，认为ALT升高者中存在着甲、乙、丙型肝炎病毒的感染，以乙肝病毒感染为主，不同型肝炎病毒存在混合感染。     

河北省赵县城廊454例献血员HCV感染的流行病学调查

近年来,由于不少血站开展单采浆活动,一些地区发生了职业性献血员之间的丙型肝炎交叉感染,探讨其流行因素和控制措施是十分必要的,我们于1994年11月14日～24日对赵县城廊村454名献血员血清进行了检测,并着重对其交叉感染因素进行了分析。 材料与方法 一、调查对象 对赵县城廊村全体献浆献血员454例进行血清学检测,并逐人详细调查献血、献浆史及肝炎史、ALT异常史等。 二、检测方法 HBsAg、抗HCV血清标本采用ELISA法检测,并由全国丙肝研究课题组重复检验,采血后24小时检测ALT,赖氏法≥25单位为异常。     

贵阳地区性乱者血清抗HCV的调查

对208例性乱、107例献血员作血清丙型肝炎病毒抗体(抗HCV)、部分乙肝病毒标志(HBVM)检测。结果献血员抗HCV阳性率1.87%,性乱者8.65%,其中伴性病者为12.7%,不伴性病者4.1%。性乱者抗HCV阳性率在男、女各年龄组间无明显差异,HCV合并HBV感染率达72.2%。结果提示,性乱者中有着不可忽视的HCV感染率,感染率高低与伴发性病或HBV感染有关。     

近期ALT升高史单采浆供者乙型肝炎和丙型肝炎病毒感染现状的调查

对一组一年内一次以上ALT升高史的单采浆供者血清中多项乙肝与丙肝病毒感染标志进行了检查,并与本地区无ALT升高史供浆者进行比较。两组检测结果分别为抗HCV:14.03%和6.45%;抗HCV-IgM:3/8和2/13;HBsAg:2.82%和0.46%;抗HBs:32.39%和25.35%;抗HBc:45.07%和33.18%;其检出率前者均高于或显著高于后者,并与ALT升高次数有显著的伴随关系。     

HCV-RNA载量与抗HCV阳性率及ALT异常率的相关性分析

目的分析实时荧光PCR定量检测HCV-RNA载量与酶联免疫吸附法检测抗-HCV和丙氨酸转氨酶(ALT)水平之间的相关性。方法采用实时荧光定量PCR(FQ-PCR)技术和酶联免疫吸附实验(ELISA),对258例疑似HCV感染阳性的血清检测HCV-RNA和抗-HCV,并同时检测ALT。结果 258例样本中HCV-RNA的阳性率为64.7%(167/258),抗-HCV的阳性率为67.1%(173/258),ALT异常率为56.2%(145/258)。抗-HCV阳性率和ALT异常率随着HCV-RNA载量升高而增加。结论 HCV-RNA载量与抗HCV(+)和ALT异常率均呈正相关性,三者联合检测可以大大降低HCV漏诊率。     

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     

上海地区638例输血后丙型肝炎病毒感染者的临床分析

目的 分析输血后丙型肝炎病毒(HCV)感染者的临床特征.方法 采用PCR检测HCVRNA载量,ELISA检测抗-HCV,分析输血后HCV感染者的年龄、原发病因、暴露年份、输血成分与输血量、潜伏期、肝功能损害和腹部超声图像改变等.结果 578例感染者中有525例(90.8%)HCV RNA载量≥3.0 log10 copy/ml(M=6.10 log10 copy/ml),其中19.2%病例为3.0～4.0log10 copy/ml、66.1%为5.0～6.0 log10 copy/ml,仅14.7%病例≥7.0log10 copy/ml.HCV RNA定性阳性率为81.5%(44/54),HCV基因型主要为1型,抗-HCV阳性率达99.8%(636/637),其阳性敏感率高于HCV RNA定量和定性检测(均为P=0.000).输血后HCV感染以40～60岁年龄段多见,85.7%病例的暴露时间为1990-1994年,10%以上的感染者中基础疾病为妇产科、骨科疾病和胃肠道出血,79.9%的病例为输入全血者,输血至临床诊断时间平均(8.5±5.5)年;90.1%感染者有肝功能损害,多数病例血清丙氨酸氨基转移酶(ALT)升高水平≤5×ULN,而血清总胆红素升高、ALT和天冬氨酸氨基转氨酶≥5×ULN水平者临床表现较多(P值分别为0.000、0.001和0.009);8.9%感染者腹部超声显示有肝硬化改变,但多见于感染期＞5年者.结论 输血后HCV感染主要集中于1990-1994年,成年人患病率较高,常伴有肝功能损害,感染期＞5年者肝硬化发生率较高,HCV基因型主要为1型,血清HCV RNA载量多为中等水平.

Abstract：

Objective To investigate me clinical-epidemiologic characteristics of patients with hepatitis C virus(HCV)infection by post blood transfusion.Methods Polymerase chain reaction (PCR)and enzynle linked immunosorbent assay(ELISA)were used to detect HCV RNA and anti.HCV,respectively.Analysis was performed on patients'age distribution,cause of primary diseases,years ofexposure,ingredient and amount of transfusion,incubation period,disorder on liver function and changes on abdominal ultrasound image,etc.Results HCV RNA levels were higher than 3.0log10 copy/ml in 90.8%infected patients、with a median as 6.10 log10 copy/ml.19.2%of the patients showed viral load 3.0 to 4.0 iog10 copy/ml,and 66.1%of them showed 5.0 to 6.0 log10 copy/ml.Only 14.7%of the infected persons had HCV RNA levels higher than 7.0 log10 copy/ml.Eighty-one point five percent(44/54)of the infected persons were confirmed as HCV RNA positive by HCV RNA qualitative analysis with HCV genotype as primarily type 1.99.8%(636/637)of the pmients were detected as anti-HCV positive by serological test.The sensitivity of serological test was higher than both quantitative and qualitative HCV RNA assays(P=0.000,P=0.000,respectively).HCV infection post blood transfusion was more seen in common people at 40 to 60 years old Most cases(85.7%)had their first exposure during 1990 to 1994.More than 10% of the cases had primary diseases aS obstetrics,orthopedics or gastrointestinal tract hemorrhage.79.9%of the patients received whole blood product transfusion.The mean interval between transfusion and clinical diagnosis was 8.5±5.5 years.90.1%of the infected patients had liver function damage,while most of them showed elevated alanine aminotransferase(ALT)no more than 5 upper limits of normal(ULN).wheteas Serum total bilirubin(TBIL).ALT and aspartate aminotransferase(AST)≥5×ULN level were showing more clinicaI manifestations(P=0.000.P=0.001,P=0.009,respectively).Abdominal ultrasound among 8.9%of the infected persons showed changes in cirrhosis,and most of them werc older than 50years of age.Conclusion Most of the post transfusion HCV infected cases happened in adulthood,and were mainly exposed during 1990 to 1994.Infected pmients usually had their liver function damaged with elevated ALT no more than 5×ULN and with medium HCV RNA levels.HCV genotype was mainly for type 1.Patients who weTe ofolder age showed higher incidence ofcirrhosis.If a patients'infection period Was longer than 5 years,he/she would show higher incidence of cirrhosis.     

输血传播性丙型肝炎病毒感染的相关因素探讨

目的研究输血传播性丙型肝炎与输血量、抗-HCV和ALT筛检献血血液、国内厂商的抗-HCV试剂盒质量的关系。方法抗-HCV采用ELISA检测，ALT用速率法测定，HCVRNA用RT-PCR定性测定，相关因素的统计分析应用2检验和相关回归分析。结果输血传播性丙型肝炎发生率与输血量X（U）呈正相关。输入经抗-HCV筛检的血液比输入未经抗-HCV筛检的血液的丙肝发生率减少79．76％，有非常显著的意义（χ^2=315．,06，P〈0．001）。献血者ALT异常数与抗-HCV阳性两者有关联性（χ^2=176．81，P〈0．001），但关系很疏远（Pearson列联系数C=0．046）。国产ELISA抗-HCV试剂盒的弱阳性重复性符合率的差异无统计学意义（χ^2=2．66，P〉0．05），合计弱阳性重复性符合率是62．84％，不确定率是37，16％；总体阳性重复性符合率之间的差异有非常显著的统计学意义（χ^2=10．02，P〈0．001），合计总阳性重复性符合率是90．01％，总不确定率是9．99％。配对比较国产ELISA抗一HCV试剂阳性检出率差异有非常显著的统计学意义（χ^2=8．05、30．11，P〈0．01）。结论随着输血量的增大，输血后丙型肝炎感染的危险性随之增大，符合Frost—Reed模型。建议血站用高质量的ELISA抗HCV试剂，并增加HCVAg或HCVRNA检测以缩短感染的“窗口期”，减少HCV病毒感染的残余风险度，保证输血安全。     

TT virus among blood donors in Alexandria

TTV is a non enveloped, single-stranded, circular- DNA virus that has been assigned to the Family Circiniviridae. The primary mode of TTV transmission was proposed to be transfusion (and hence its name). Little is known about the clinical significance and the natural history of TTV infection. Hence, responsibility of the virus for specific liver disease is still debated. In our study, we tested ninety five blood donors attending Kom EL-Decka regional blood bank in Alexandria for the presence of TTV DNA in their sera by PCR technique. The same samples were tested for ALT and AST levels by colorimetric technique and for HBsAg and anti-HCV by the ELISA technique. Out of the 95 blood donors, 46 (48.4%) had TTV DNA in their sera. None of the 95 blood donors included in this study was positive for HBsAg, while 22 (23.2%) were anti-HCV positive. Out of the 22 anti-HCV positive blood donors, 13 (59.1%) were TTV DNA positive, while out of the 73 anti-HCV negative blood donors, 33 (45.2%) had TTV DNA in their sera. There was no statistically significant difference between the prevalence of TTV DNA and anti-HCV in blood donors. No biochemical evidence of liver disease potentially linked to the TTV infection was observed in our blood donors who were TTV DNA positive. Furthermore, the occurrence of elevated serum AST and ALT was most often linked to HCV rather than TTV.     

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.     

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。     

A higher than expected recovery rate from hepatitis C infection amongst adolescents: a community study in a hepatitis C-endemic township in Taiwan

This study investigated the prevalence of antibody to hepatitis C virus (anti-HCV), evaluated clinical manifestations of hepatitis C, and explored the risk factors amongst adolescents in an HCV-hyperendemic area in Taiwan. In December 1999, 713 students aged 13-16 years from Taishi township, in central Taiwan, were enrolled in a screening program for anti-HCV and alanine transaminase (ALT) status. Fourteen participants (M/F = 6/8) were positive for anti-HCV. Eight of the 14 later proved to be negative for HCV RNA, and they demonstrated relatively low sample rate/cut-off rate (S/CO) ratios (1.05-11.83) for anti-HCV tests. All HCV RNA negative cases had normal serum ALT levels. The other six (43%) seropositive students demonstrated HCV viraemia and greater S/CO ratios (25.66-77.49). Two of these six participants had elevated serum ALT levels. Compared to anti-HCV-negative subjects, anti-HCV-positive students exhibited significantly greater rates of exposure to one or more of the following: blood transfusion, tattooing, and earlobe piercing. This study group has a greater prevalence (2%) of anti-HCV than the general Taiwanese population at the same age. The study also reveals a lower rate (43%) of chronicity of HCV infection than that reported in the literature.     

输血后丙型肝炎前瞻性研究

在开展筛查丙型肝炎抗体（抗－ＨＣＶ）之前，在河北省甲、乙两地前瞻性调查了输血后丙型肝炎（ＰＴＨＣ）。甲地献血员在献血前筛查ＨＢｓＡｇ和ＡＬＴ，观察了６４名受血者；乙地献血员献血前不筛查任何指标，观察了９０名受血者。ＰＴＨＣ发生率，甲地为２１．９％，乙地为４４．４％；输血后抗－ＨＣＶ阳转率分别为１８．８％和４５．６％；输入抗－ＨＣＶ阳性血发病率甲地为５５．６％，乙地为８３．３％；输入抗－ＨＣＶ阴性血发病率甲地为７．３％，乙地为４．２％。ＡＬＴ首次异常距输血时间甲地为５１．９±２０．９天，乙地为４８．２±１６．８天；抗－ＨＣＶ阳转距输血时间甲地为４２．４±１５． ９天，乙地为３８． ４±１１．８天。对ＰＴＨＣ病例随访 ５年，临床痊愈率，病后１、２、３、４、５年分别为４５．８％、５１．７％、５５．９％、６２．１％和７４．５％；ＡＬＴ异常率各为４０．７％、４４．８％、３２．２％、１５．５％和１２．８％；抗－ＨＣＶ阳性率各为９８．３％、９４．８％、７９．７％、７２．４％和７５．５％；ＨＣＶ ＲＮＡ阳性率各为７３．９％、６９．６％、５８．８％、缺和４１．２％。这些结果表明抗－ＨＣＶ阳性血有强传染性．抗－ＨＣＶ和ＨＣＶＲＮＡ?     

HCV RNA检测在献血者筛选中的应用分析

目的　探讨我国目前采供血模式下将HCVRNA检测用于献血者筛选的可行性与必要性。　方法　采用HCV核酸扩增酶免检测技术检测 4170例抗 -HCV阴性及 76例抗 -HCV阳性献血者血清HCVRNA。　结果　 4170例抗 -HCV阴性血清中未检出HCVRNA阳性 ,76例抗 -HCV阳性者中 ,两种试剂检测抗 -HCV阳性者HCVRNA检出率 48.0 % ,单试剂检测抗 -HCV阳性者HCVRNA检出率 9.80 %。　结论　HCVRNA检测目前尚不能完全取代血清学检测用于献血者筛选。