维持性血液透析患者丙型肝炎病毒感染情况的调查与护理预防

目的 调查本透析中心6年间维持性血液透析患者丙型肝炎病毒的感染率变化情况,分析丙型肝炎病毒感染的易感因素,探讨预防丙型肝炎病毒传播的措施.方法 检测所有长期维持性血液透析患者丙型肝炎抗体,丙型肝炎RNA,并收集相关临床资料.结果 2004年155例透析患者中丙型肝炎感染率为10.3%.2009年228例患者中丙型肝炎抗体阳性率为8.8%.2010年300例丙型肝炎的感染率为7.3%.其中111例患者在我中心透析6年以上,累计透析85100余次,没有新发丙型肝炎感染.显示输血次数和肾移植病史是并发丙型肝炎的危险因素.结论 近6年来我中心的血液透析患者丙型肝炎感染率呈下降趋势.通过减少输血,严格执行血液透析时防止血源性传播疾病操作规程,能够减少丙型肝炎在透析患者之间的传播.

Abstract：

Objective To investigate the hepatitis C virus (HCV) infection in patients with maintained hemodialysis for 6 years in the hemodialysis center of Beijing Friendship Hospital, and to analyse the risk factor of HCV infection. Methods HCV RNA , the serum virus antibody were detected in hemodialysis patients . The relationship between the infection of hepatitis virus and the dialysis time, blood infusion and hepatic function was analysed. Results The percentage of HCV infection patients was 10.3% ,8.8%, and 7.3% in 2004,2009,2010 respectively. 111 patients were treated in our center for more than 6 years. There was no new HCV infection in these group patients during 6 years. Blood infusion and the history of kidney implantation were the risk factors. Conclusion The percentage of HCV infection in hemodialysis patients was reduced in our dialysis center. Avoidance blood transfusion and infection control of blood purification standard operating procedure are the major ways to prevent transmit HCV in patient with MHD.     

二家血液透析室丙型肝炎传播途径调查

丙型肝炎是维持性血液透析患者常见的传染病,尚无有效的治疗方法,主要在于预防.目前血液透析采用一次性材料,广泛使用红细胞生成素,减少了输血,但丙型肝炎发生率仍然高,已引起有关学者的关注.近年来,本地区有2家血液透析室发生了19例丙型病毒性肝炎传染事件,我们分别进行了调查,现报告如下.     

Hepatitis virus infection (HBV and HCV) in eleven Japanese hemodialysis units.

To evaluate hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in hemodialysis (HD) units, serum samples from 607 HD patients and 150 staff members at 11 HD units in Japan were collected, and were compared with those from 704 ordinary blood donors as a control. Serum samples subjected to a first generation ELISA for antibody to HCV (anti-C100-3) and were tested by ELISA for HB surface antigen (HBs-Ag), antibody to HBs-Ag, and antibody to HB core antigen (anti-HBc) as HBV markers. We also tested for HCV infection with a second generation ELISA (for antibodies to C22-3, C33c, and C100-3) in 120 HD patients and 30 staff members at 2 selected HD units. Of 607 HD patients, 104 (17%) were positive for anti-C100-3 and 221 (36%) for HBV markers, indicating a much higher prevalence of HCV and HBV infection among HD patients than among ordinary blood donors (0.9% and 18%, respectively). Of 159 patients without a history of blood transfusion, 17 (11%) were positive for anti-C100-3, showing that HCV infection can be acquired without transfusion. The incidence of anti-C100-3 varied from 0% to 53% at different HD units, and HBV markers varied from 17% to 50%. Our study detected a high prevalence of co-infection with HBV and HCV, suggesting that HCV infection may contribute to chronic liver dysfunction in HD patients. Out of 150 staff members, 3 (2%) were positive for anti-C100-3, whereas 25 (17%) were positive for anti-HBc (indicating prior HBV infection).(ABSTRACT TRUNCATED AT 250 WORDS)     

Hepatitis G virus infection in hemodialysis patients and its relationship with hepatitis C virus infection

Our aim was to study the characteristics of hepatitis G virus (HGV) infection in hemodialysis (HD) patients. We evaluated 108 patients from two different units (A: 67 patients; B: 41 patients). HGV RNA and HCV RNA were detected by PCR. Nineteen patients (17.6%) were HGV RNA positive (20.9% in unit A and 12.2% in unit B (NS)). HCV RNA was positive in 19 patients (17.6%) (28.4% in unit A and 0 in unit B (p < 0.01)). Eight patients were HGV RNA and HCV RNA positive (group I), 11 HGV RNA positive (group II), 11 HCV RNA positive (group III), and 78 negative for both viruses (group IV). Time on HD was 51.3 +/- 37.0 months for group I, 36.0 +/- 27.9 months for group II, 63.5 +/- 40.2 months for group III, and 26.4 +/- 27.1 months for group IV (p < 0.01 for I and III). Seven patients (87.5%) from group I, 9 (81.8%) from group II, 10 (90.9%) from group III, and 44 (56.4%) from group IV had a history of transfusion (p < 0.03 for I, II and III). Two patients (25%) from group I, none from group II, 5 (45.4%) from group III, and 6 (7.7%) from group IV had chronic ALAT elevation (p < 0.01 for I and III). We conclude that HGV infection was frequent in our HD patients, related to transfusions and independent of HCV prevalence, and that HGV infection itself was not a cause of ALAT elevation suggesting chronic hepatitis.     

Hepatitis B virus infection in hemodialysis patients

Patients with chronic renal failure on hemodialysis suffer from impaired immune defense mechanisms. A defect in costimulatory signalling from antigen-presenting cells (APCs) for the antigen-specific activation of T cells leads to immune incompetence, particularly toward viral infections. The epidemiologic situation of dialysis patients who are treated in centers together with other immunocompromised patients and who need blood access 3 times weekly places them at a high risk for viral hepatitis B. Clinically, the infection shows a mild and subclinical, often anicteric, course, leading to chronic infection in the majority of cases. Typical consequences such as cirrhosis and hepatocellular carcinoma may occur, however, seem to be less frequent than in hepatitis B-infected persons with normal renal function. Protection by vaccination is also hampered by the immune defect. Nevertheless, a high percentage of vaccinated patients is still desirable for infection control. Treatment of hepatitis B in dialysis patients is difficult because interferon-alfa is less effective and frequently leads to side effects. Lamivudine may become a future alternative, however, current experience is limited.     

Hepatitis C virus in hemodialysis patients.

Anti-HCV prevalence in 284 hemodialysis patients was assessed using the Abbott HCV-EIA test. Anti-HCV positivity was found in 19.4% of patients, was higher in males than in females and progressively increased with age. A correlation between time of dialysis treatment, transfusions and ALT course was found. These data suggest that HCV infection is a very important risk in dialysis units.     

Hepatitis B virus infection in hemodialysis: recent discoveries

Controlling the spread of HBV infection in dialysis units has been one of the major advances in the treatment of patients with ESRD. The frequency of HBsAg carriers on maintenance dialysis is low in developed countries. However, prevalence and incidence rates of HBV infection among dialysis patients in less developed countries remain very high. Patients on maintenance dialysis and chronic HBsAg carriage are typically anicteric and rarely develop symptoms of hepatitis. The relationship between HBsAg and aminotransferase activity in dialysis population is stronger than has so far been recognized. HBsAg positivity is significantly associated with hepatocellular damage in dialysis patients. Aminotransferase activity in dialysis population is usually depressed; this hampers the recognition of HBV-related liver disease among dialysis patients by biochemical tests. The HBV viral load in HBsAg positive patients is low and stable over time; the low mortality attributable to liver disease in dialysis patients could be related to this finding. Numerous assays for detecting HBV DNA in serum of dialysis patients are available; they should not be used for purposes of routine screening within dialysis units. Continued implementation of the long-recommended infection control procedures against HBV within dialysis units is strongly suggested.     

Hepatitis C infection in kidney transplantation

Liver disease is an important cause of morbidity and mortality among solid organ transplant recipients. Twenty-five percent of long-term survivors after kidney transplantation will die because of liver failure. Hepatitis C (HCV) and hepatitis B (HBV) infection are by far the most significant causes of chronic liver disease in this patient population. A comprehensive review is provided dealing with the clinical impact of HCV infection in different scenarios such as: hemodialisis, acute infection in kidney transplant patients, and the debated policy of performing kidney transplantation from HCV-positive kidney donors in positive recipients. Some related conditions such as diabetes and kidney-related HCV are discussed. Finally, an approach as well as a treatment proposal is provided by the authors.     

Hepatitis C virus and death risk in hemodialysis patients

In maintenance hemodialysis (MHD) patients, hepatitis C virus (HCV) infection is common and may be associated with poor clinical outcomes. It was hypothesized that HCV infection would be associated with high all-cause and cardiovascular mortality in these patients after controlling for demographic and clinical characteristics, including surrogates of malnutrition-inflammation complex syndrome. A national database of 13,664 MHD patients who underwent HCV antibody serology testing at least once during a 3-yr interval (July 2001 through June 2004) was analyzed. Measurements included third-generation HCV enzyme immunoassay and routine laboratory measurements. The HCV enzyme immunoassay was reported positive in 1590 (12%) patients. In logistic regression models that included case mix and available surrogates of malnutrition-inflammation complex syndrome, HCV infection was associated with younger age, male gender, black race, Hispanic ethnicity, Medicaid insurance, longer dialysis vintage (duration), unmarried status, HIV infection, and smoking history. In proportional-hazards regressions, the mortality hazard ratio that was associated with HCV infection was 1.25 (95% confidence interval 1.12 to 1.39; P < 0.001). Mortality hazards were higher among incident (dialysis duration <6 mo) than prevalent HD patients. Subgroup analyses indicated that HCV was associated with higher all-cause and cardiovascular mortality across almost all clinical, demographic, and laboratory groups of patients. Hence, in MHD patients, HCV infection exhibits distinct demographic, clinical, and laboratory patterns, including associations with higher dialysis treatment vintage, and is associated with higher mortality. More diligent efforts to prevent and treat HCV infection may improve outcomes in MHD patients.     

Hepatitis C virus screening strategies in haemodialysis units.

Sir, Hepatitis C virus (HCV) infection remains a significant publichealth concern in haemodialysis (HD) patients. Although generallyasymptomatic, about 70–85% of infections become chronic,and persistent infection may be associated with a wide spectrumof outcomes, ranging from mild non-progressive liver damageto severe chronic hepatitis, which progresses to cirrhosis,end-stage liver disease, and hepatocellular carcinoma. Currently, it is still unclear how HD patients become infected.Nevertheless, both intradialysis (number of blood transfusions,duration and mode of dialysis, prevalence of     

Hepatitis B and hepatitis C virus infection and outcome of hemodialysis and kidney transplant patients

AIM: A comparison of the outcome of hepatitis virus-positive and -negative kidney transplant and hemodialysis patients was the aim of this investigation. MATERIALS AND METHODS: The study involved 384 kidney transplant patients (67 HBsAg positive, 39 anti-HCV positive, 278 hepatitis negative), transplanted between 1987 and 2001, and 403 hemodialysis patients (128 HBsAg positive, 83 anti-HCV positive, 192 hepatitis negative) who had started hemodialysis and were referred to the kidney transplant waiting list during the same period. RESULTS: Hemodialysis patients were older than transplant patients. Comparison of the groups' survival rates, adjusted for patient age, showed that all kidney transplant patients survived longer than hemodialysis patients (p < 0.001). HBV infection had a negative impact on patient survival, especially in hemodialysis patients. HCV infection did not have a significant influence on patient survival. Cardiovascular disease was the main cause of death of all hemodialysis- and hepatitis-negative transplant patients. Liver failure was one of the leading causes of death in HBV-positive transplant patients. Mortality risk was higher for older patients, HBV-positive and -negative hemodialysis patients. CONCLUSIONS: Kidney transplantation offers longer survival for hepatitis-positive and -negative hemodialysis patients. HBV but not HCV infection had a negative impact on ESRD patient survival.     

Hepatitis C virus-related acute and chronic hepatitis in hemodialysis patients.

The incidence of HCV antibodies has been evaluated in 123 chronic hemodialysis (HD) patients (Group A; 55 M and 68 F) and in 37 consecutive HD patients (group B) admitted to our hospitals for acute hepatitis. In group A, HCV antibodies were present in 27% of the patients. 20 of 36 (55%) had previously received blood transfusions. 21 patients (58%) were also positive for HBV Ab. In 8 patients, ALT were significantly increased. In group B, the diagnosis of HCV-related acute hepatitis was made in 11 patients. 8 of them had previously received blood transfusions. Seroconversion occurred 2-3 months after onset of the disease.     

Hepatitis C virus in dialysis units: a multicenter study.

Three hundred and eighty-seven chronic hemodialysis patients were evaluated, in a multicenter study, to investigate the epidemiology of hepatitis C virus. In anti-HCV seropositive patients, serum ALT values and blood transfusions were retrospectively compared; blood donors were studied for serum transaminases. In seropositive patients without previous blood transfusions, analysis of dialysis schedule was done. Eventually, the intrafamilial transmission of hepatitis C virus was studied in 104 family members. The prevalence of HCV infection in hemodialysis patients was 15.7%. The incidence of acute hepatitis was frequent, while chronic hepatitis incidence was less than expected (17.5%). Intrafamilial diffusion was low (1.9%). Blood-transfusion-related infections seem to be negligible, while cross-contamination in dialysis units seems to be very important.