血液透析患者和透析中心工作人员丙型肝炎病毒感染的研究

目的：研究血液透析患者和透析中心工作人员丙型肝炎病毒（ＨＣＶ）的感染率、影响因素及临床特点。方法：应用第二代酶链免疫吸附测定（ＥＬＩＳＡ）法、反转录－套式ＰＣＲ法检测了１５４例血透患者和４６名透析中心工作人员的血清抗－ＨＣＶ抗体及ＨＣＶ－ＲＮＡ。结果：血透患者抗－ＨＣＶ阳性率为７０．８％，ＨＣＶ－ＲＮＡ阳性率为７１．７％，ＨＣＶ感染率达８２．１。透析中心工作人员ＨＣＶ感染率为０％。血透患者－ＨＣＶ与ＨＣＶ－ＲＮＡ的相关性较差。ＨＣＶ感染率与输血次数、透析年限显著相关，且输血次数的相对危险度（ＲＲ＝６．６７５）大于透析年限（ＲＲ＝３．８９７）。血源抗－ＨＣＶ筛查前、后两组ＨＣＶ感染率分别为９５．３％和５８．０％，差异十分显著（Ｐ＜０．００１）。ＨＣＶ阳性与ＨＣＶ阴性患者肝功能异常率无显著差异。结论：①血透患者ＨＣＶ感染率明显高于普通人群；而透析中心工作人员ＨＣＶ感染率极低（０％）。②透析年限和输血次数是透析患者ＨＣＶ感染传播的主要危险因素，且输血对ＨＣＶ感染的相对危险度较透析年限相对更大。血源抗－ＨＣＶ筛查能有效降低血透患者ＨＣＶ感染率。③血清转氨酶水平不能作为血透患者ＨＣＶ感染的敏感指标。     

维持血液透析的尿毒症病人乙型丙型肝炎病毒感染情况研究

目的　了解北京地区 (东城、宣武、朝阳区 )接受规律性血液透析患者 ,乙型肝炎病毒 (HBV)和丙型肝炎病毒 (HCV)的感染情况及其相关因素。方法　 1998年 3～ 12月在北京协和医院、朝阳医院等 4家医院血液净化中心 ,长期维持血液透析的尿毒症患者 2 2 5例 ,血透中心工作人员及健康献血者 5 0例为对照组。分别用PCR法和高敏PCR法检测HBVDNA、HCVRNA ,ELISA法检测乙肝两对半及丙肝抗体 ,并分析其与透析时间、输血、肝功能损害的关系。结果　 2 2 5例血液透析病人中 ,HCVRNA阳性 37例 (16 4 %) ;HBVDNA阳性 3例(1 33%)。多元回归分析表明 :输血和透析时间是丙型肝炎感染的危险因素。共有 3 0 %(3/ 99)的病人同时感染乙肝和丙肝 ,均有肝功能的损害和临床症状 ,8 1%(8/ 99)HBcAb阳性患者同时合并HCV感染。结论　血液透析病人乙肝和丙肝感染远高于对照组 ,透析时间和输血次数是丙肝感染的危险因素 ,HBV和HCV同时感染问题值得重视。     

肝病与乙型、丙型肝炎病毒感染关系的探讨

本文采用ELISA法对25例慢性肝炎，105例肝硬化，64例肝癌，以及8例急性黄疸型肝炎进行了HBV标志物及抗－HCV的检测，结果：HBV感染率为80．6％，抗－HCV检测阳性率为46％，二者均阳性的双重感染率为32％。其中肝癌组双重感染明显高于肝硬化组，P＜0．001。单纯抗-HCV检出率为10．8％，说明HBV是引起肝炎，肝硬化，肝癌的主要原因，而CV感染也是其致病因素。本文对有输血史的慢性肝炎，肝硬化，肝癌100例进行抗－HCV检测其阳性率为59％，而02例无输血史的肝病患者抗－HCV检出率为25％，输血组抗－HCV检出率明显高于无输血组，P＜0．001。其中慢性肝炎，肝硬化，肝癌病人输血组抗－HCV检出率亦明显高于无输血组，各组P＜0．001，故提示，HCV感染与输血有密切关系。50例HBV标志物阴性的健康献血员抗－HCV阳性率为6％。     

血液透析患者HCV感染的危险因素

目的 研究血液透析患者HCV感染的相关因素。 方法 血清采自血透前、血透后2-60月的10例肾衰患者,用ELISA检测抗HCV,用PCR法检测HCV,RNA和HCV基因型。 结果 10例患者透析前无HCV感染。透析后2-60月,3例抗HCV阳性(30％),2例HCV RNA阳性(20％),其基因型均为HCVⅡ型。10例患者中7例有输血史,其中4例(57％)HCV感染,所有抗HCV阳性和HCV RNA阳性患者均有输血史。而无输血史的3例患者未见HCV感染。两组有非常显著性差异(P<0.001)。HBV感染与HCV感染无相关性。 结论 反复输血是血透患者感染HCV的高危因素,长期血液透析是参考因素。     

湖北省维持性血液透析患者丙型肝炎病毒感染调查

目的：调查维持性血液透析患者丙型肝炎病毒（HCV）感染情况,并探讨其相关危险因素。方法;对湖北省84所医院3608例维持性血液透析（MHD）患者,采用ELISA法检测血清标志物HCV抗体。同时调查其输血史和透析史,进行相关性分析。结果：3608例MHD患者中,HCV感染率5．88％。有输血史HCV感染率（7．12％）显著高于无输血史者（2．13％,P〈0．01）。HCV阳转率透析时间小于1年为0．98％,透析1～2年为4．19％,透析2～3年为4．59％,透析3年以上为13．06％（P〈0．01）。且随着每周透析次数的增加,HCV的阳转率也明显上升（P〈0．05）。接受过1所医院透析的患者,HCV阳转率为3．09％,接受过2所为5．84％,接受过3所为7．44％,接受4所及以上为11．29％（P〈0．01）。结论：反复输血、透析时间长、透析次数多、接受多家医院透析是MHD患者感染HCV高的重要因素。减少输血、加强透析治疗环节院内感染的质量控制对预防HCV感染有重要意义。     

维持性血透患者HBV和HCV感染的原因与预防

目的调查我院维持性血液透析患者HBV和HCV的感染状况及影响因素。方法按接受维持性血液透析的时间先后,将435例患者分为4组:第一组16例,透析时间≥10年;第二组47例,5年≤透析10年;第三组184例,1年≤透析5年;第四组188例,透析1年。采用酶联免疫分析法测定HbsAg和抗-HCV。结果在435例患者中,HBV感染80例(18.4%),HCV感染33例(7.6%);第一组HCV感染14例(87.5%),明显高于第二、第三和第四组(14.9%,2.7%和3.7%,P0.01);第四组HBV感染44例(23.4%),显著高于第一、第二和第三组(0.0%,17.0%和15.2%,P0.01)。结论血液透析患者是HBV和HCV感染的高危人群,透析时间、输血和透析器复用等是医院感染的重要危险因素。     

血液透析患者乙、丙型肝炎感染的状况

目的研究血液透析患者乙、丙型肝炎感染状况及感染途径。方法对４９例维持性血液透析患者用套式逆转录聚合酶链反应方法（ＲＴＰＣＲ）检测了乙型肝炎病毒脱氧核糖核酸（ＨＢＶＤＮＡ）及丙型肝炎病毒核糖核酸（ＨＣＶＲＮＡ），用第二代酶联免疫吸附法（ＥＬＩＳＡ）检测丙型肝炎抗体、乙型肝炎标志物（ＨＢＶＭ）。结果透析患者乙型肝炎感染率５３．１％，丙型肝炎感染率６９．４％。输血组乙、丙型肝炎感染率大于未输血组；透析程２４个月以上者丙型肝炎感染率大于透析１２个月以内者（Ｐ＜００５）。ｌｏｇｉｓｔｉｃ多元回归分析显示，透析年限的增加是丙型肝炎感染的主要因素，提示透析程的危险度大于输血危险度。２０份血站提供的血制品有３份ＨＣＶＲＮＡ阳性，２０份复用透析器经消毒处理后检测出２份ＨＣＶＲＮＡ阳性，９例工作人员ＨＣＶＲＮＡ及ＨＢＶＤＮＡ均阴性。结论加强透析室的管理及工作人员的防护，减少输血及透析器的复用，对减少透析中乙、丙型肝炎感染至关重要     

单采血浆和输血途径感染HIV的患者中HBV和HCV感染状况

目的 了解单采血浆和输血途径感染艾滋病病毒(HIV)的人群中,乙型肝炎(乙肝)病毒(HBV)、丙型肝炎(丙肝)病毒(HCV)的感染状况. 方法 应用酶联免疫吸附试验(ELISA),对825 名HIV阳性的单采血浆献血员和受血者,检测乙肝病毒表面抗原(HBsAg)和丙肝病毒抗体(抗-HCV). 结果 单采血浆和输血途径感染HIV的人群中,HBV、HCV的感染率分别为3.76%、72.24%.其中单采血浆献血员中,HCV感染率(81.85%)高于输血人群(56.03%),而HBV感染率(1.54%)低于输血人群(7.49%)(P均＜0.01). 结论 在单采血浆和输血途径感染HIV的患者中,有很高的HCV感染率,而HBV感染率较低.     

维持性血液透析致丙型肝炎病毒感染临床特点分析

目的 探讨维持血液透析致丙型肝炎病毒(HCV)感染的临床特点及转归.方法 回顾性分析了2007年12月31日北京大学人民医院透析中心血液透析的99例患者中感染丙型肝炎病毒感染者的临床资料,包括人口学资料、输血情况,与透析相关的感染控制措施及血清转氨酶、胆红素、白蛋白以及HCV RNA、HCV抗体和肝脏B超检测指标等.结果 99例维持血液透析患者中有20例感染HCV,患病率为20.2%,其中HCV感染患者的年龄平均为(63.3±10.9)岁,透析龄为(79.9±38.7)个月;发现HCV感染的平均持续时间为(32.6±22.6)个月,其中最长的1例患者为103.5个月.HCV感染者中有16例(80%)感染HCV前有输血史.曾有4例患者血清HCV RNA阳性,其中1例经应用干扰素治疗半年后持续HCV RNA转阴,1例1月后HCV RNA自行转阴,其余2例患者血中HCV RNA仍阳性.抗HCV阳性血液透析患者的年龄及透析龄均明显大于抗HCV阴性者.实行严格感染控制措施后血液透析患者平均每年丙型肝炎病毒感染的新发病例(1.2%)较前(5.3%)明显下降(P<0.05).Logistic回归分析显示输血(P=0.001)及透析龄(P=0.001)是血液透析患者HCV感染的独立危险因素.结论 输血及透析龄是血液透析患者感染HCV的独立危险因素.实行严格感染控制措施可降低血液透析患者HCV感染的患病率.     

慢性丙型肝炎患者混合或重叠感染其他病原体状况分析

目的了解丙型肝炎病毒（HCV）感染者混合或重叠感染乙型肝炎病毒（HBV）、人免疫缺陷病毒（HIV）和梅毒螺旋体（TP）的状况,为HCV感染的防治提供依据。方法采用ELISA法检测乙型肝炎病毒标志物、抗TP和抗HIV;采用化学发光法检测抗HCV;采用蛋白印迹法确认HIV感染。结果在169例HCV感染者中,重叠感染HBV 25例（14.8%）、HIV 4例（2.4%）、TP 9例（5.3%）,重叠感染HBV和TP 2例（1.2%）,重叠感染HBV和HIV 2例（1.2%）;静脉吸毒者重叠感染HIV（6.7%）和TP（11.1%）的比例均明显高于非静脉吸毒者（P〈0.05）;男性患者重叠感染HBV的比例（19.7%）明显高于女性患者（3.8%,P〈0.01）,女性患者重叠感染TP的比例（11.5%）明显高于男性患者（2.6%,P〈0.05）。结论随着感染方式的多元化,慢性丙型肝炎患者重叠感染其他病原体的情况更加常见。     

Lower Hepatitis G Virus Infection Prevalence Compared to Hepatitis B and C Virus Infection Prevalences

To more accurately determine the seroprevalence of hepatitis G virus (HGV) infection, we surveyed antibody to HGV (anti-E2) by enzyme-linked immunosorbent assay (ELISA) and HGV RNA by nested polymerase chain reaction (PCR) in 298 residents of a hepatitis C virus (HCV)-endemic area of Japan and in 225 hemodialysis patients. We then compared these findings with known HCV and hepatitis B virus (HBV) infection prevalences. Anti-E2 and HGV RNA prevalences were 32 (10.7%) and 5 (1.7%) in the residents and 24 (10.7%) and 10 (4.4%) in the hemodialysis patients, respectively. Anti-E2 and HGV RNA concurrence was found in two of the hemodialysis patients. Total HGV marker (anti-E2 and/or HGV RNA) prevalences [37 (12.4%) in residents and 32 (14.2%) in hemodialysis patients], were significantly lower than the prevalences of antibody to HCV (anti-HCV) by ELISA [59 (19.8%) and 96 (42.7%)], and antibody to hepatitis B core antigen (anti-HBc) by radioimmunoassay (RIA) [87 (29.2%) and 101 (44.9%)] (P < 0.05). The anti-HCV prevalence in subjects with total HGV marker was significantly higher than in those without total HGV marker. There was no significant difference in anti-HBc prevalence between those with and without total HGV marker. The viremic rate was highest in HCV infection (HCV RNA by PCR/anti-HCV) (83.2%), with HGV infection (HGV RNA/total HGV marker) (21.7%) intermediate, and HBV infection (hepatitis B surface antigen by RIA/anti-HBc) (5.3%) lowest (P < 0.05). These findings indicate that HGV infection was less endemic than HCV and HBV. HGV was eliminated naturally more frequently than HCV infection and less frequently than HBV infection.     

庚型病毒性肝炎17例的临床和病原学分析

目的:对南京地区庚型病毒性肝炎的临床和病原学特点进行分析。方法:用反转录聚合酶链反应(RT-PCR)法检测血清HGV-RNA。从274例病毒性肝炎患者中检测出17例庚型病毒性肝炎,观察其临床表现及血清病原学标志,并分析庚型肝炎病毒(HGV)部分核酸序列。结果与结论:17例患者男性成年人多见,全年散发,经输血感染为重要传播途径。HGV可以单独感染,也可重叠(混合)其它肝炎病毒感染。少数为急性肝炎,多数为慢性肝炎或肝硬化,尤其在重叠(混合)感染。单纯HGV感染者症状轻,多隐匿发病,肝功能损害较轻。重叠(混合)感染者多有慢性肝炎的症状,与HBV重叠(混合)感染时有形成重型肝炎的趋势。核酸序列分析表明HGV南京株部分核苷酸序列与HGV美国株HGU 44402、HGU 45966、HGU 36380及HGV河北株在对应位置的核苷酸同源性从87.27%~93.94%,可能HGV有不同的基因型。     

Clinical significance of hepatitis G virus infection in patients on long-term haemodialysis

Infection with the newly discovered hepatitis G virus (HGV) was analysed in 163 patients on long-term haemodialysis to clarify its prevalence and clinical significance. Hepatitis G virus RNA in serum was measured by polymerase chain reaction with primers corresponding to the putative non-structural 5’ region. Of the 163 patients, three (1.8%) were positive for hepatitis B surface antigen, 40 (24.5%) were positive for hepatitis C virus (HCV)-RNA and 16 (9.8%) were positive for HGV-RNA. Five of the 16 patients with HGV-RNA were also positive for HCV-RNA. Patients with HCV and HGV coinfection had undergone a longer duration of haemodialysis (P=0.001) and had higher units of transfusion (P=0.031) compared with those without hepatitis virus infection. Transfusion history was significantly higher (P=0.039) in patients with only HGV infection than in those without hepatitis virus infection. Hepatitis C virus RNA concentration was higher (P=0.032) in patients with HCV and HGV coinfection than in those with HCV infection only, but alanine aminotransferase (ALT) levels were similar between these two groups. In conclusion, about 10% of patients on haemodialysis were infected with HGV and the infection was closely associated with transfusion history.     

GB virus-C/hepatitis G virus infection in a hepatitis C virus endemic village: prevalence in residents with low educational attainment and frequent recovery in females

AIMS/BACKGROUND: GB virus-C/hepatitis G virus (HGV) is a newly identified flavivirus, which may share the same mode of transmission as hepatitis C virus (HCV). The aim of this study was to investigate associated factors of HGV infection and clearance in a HCV endemic village in southern Taiwan. METHODS: Five hundred and ninety-four residents of a village in southern Taiwan were enrolled for hepatitis virus screening. Clinical features were recorded and a questionnaire addressing the possible routes of transmission was filled in by the participating residents. RESULTS: The prevalence of antibody to hepatitis C virus and hepatitis B surface antigen in the 594 residents was 70.7% and 19.5% respectively. Of the 399 residents tested for HGV RNA, GB virus-C/Hepatitis G virus envelop 2 protein (HGV-E2) antibody, and HCV RNA, the prevalence was 13.5%, 25.3%, 53.1% respectively. Multivariate logistic regression analysis showed that low educational attainment was associated with HGV infection, old age and low educational attainment were associated with HCV infection, and female gender was associated with HGV clearance. Alanine aminotransferase (ALT) values were significantly higher for residents with HCV infection alone, HBV infection alone, and co-infection of HCV and HBV than for those without HBV, HCV, and HGV infection. There were no differences in ALT values between subjects with HGV infection alone and those without HBV, HCV, and HGV infections. Residents with co-infection of HGV and HBV, or HGV and HCV had ALT values similar to those with HBV or HCV infection alone. CONCLUSION: HGV infection is common in the HCV endemic village. The transmission of HGV is closely related to low educational attainment. HGV clearance is frequently encountered in females. Co-infection of HGV does not compound hepatocellular inflammation.     

Hepatitis G virus exposure in dialysis staff

Hepatitis G virus (HGV) is a blood-borne virus. Some present data demonstrate an occupational risk of HGV infection in medical staff of dialysis units. The aim of this investigation was to assess the prevalence of HGV exposure in dialysis staff. This study was performed in a main dialysis unit in Iran. In 27 dialysis staff, HGV exposure was detected serologically by the presence of anti HGV envelope protein E2 (anti-E2) by an enzyme-linked immunosorbent assay, and compared with 77 hemodialysis (HD) and 13 continuous ambulatory peritoneal dialysis (CAPD) patients. All of them were also screened for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis C antibody (anti-HCV). A low prevalence of HGV exposure was found in the dialysis staff (0%), which nearly corresponded to the prevalence of the dialysis patients (HD 3.89%, CAPD 0%). The prevalence of anti-HCV and anti-HBs in staff was 37.03% and 33.33%, respectively, which was higher than HGV anti-E2. The prevalence of HGV exposure was low in dialysis staff in our study, and was near to the prevalence of HGV exposure in dialysis patients. Therefore, it can be concluded that the occupational risk for HGV exposure in our investigation was minimal.     

庚型肝炎病毒感染对急性肝炎致病性的探讨

目的 探讨急性肝炎患者肝组织中庚型肝炎病毒（ＨＧＶ）的感染状况及其致病性。方法 采用免疫组织化学方法对３７例血清学肝炎病毒标记甲￣戊型均阴性的急性肝炎患者肝穿肝组织中的ＨＧＶ ＮＳ５抗原等进行检测,并对ＨＧＶ感染的致病性进行研究。结果 ＨＧＶ ＮＳ５抗原的检出率为３７．８％（１４／３７）,其中ＨＧＶ ＮＳ５单项阳性４例（急性庚型肝炎组）。结果 ＨＧＶ ＮＳ５抗原的检出率为３７．８％（１４／３７）,     

聚合酶链反应和杂交试验检测上海地区庚型肝炎病毒感染的初步报告

为探讨上海地区庚型肝炎病毒感染的现状，采用逆转录套式聚合酶链反应（ＲＴＮｅｓｔｅｄＰＣＲ）检测庚型肝炎病毒（ＨＧＶ／ＧＢＶＣ）核酸（ＨＧＶＲＮＡ）。结果在各类患者和助血员中ＨＧＶＲＮＡ的检出率分别是：血液透析和肾移植为１５７％（８／５１）、丙型肝炎为３３％（１／３０）、乙型肝炎为０（０／１９）、散发性非Ａ～Ｅ型肝炎为０（０／２８）、义务助血员为７５％（５／６７）。提示ＨＧＶ感染多为无症状或亚临床型，常与ＨＣＶ重叠感染，并与输血密切相关。作者肯定了上海地区存在庚型肝炎，指出筛选助血员对控制输血后庚型肝炎至关重要。