输血后肝炎的随访研究

１９８９～１９９０年对太原地区的输血者及其对照进行随访，在输血前或对照入院一周内采血。输血或对照采首份血后２周、４周、１２周、和２４周采血，检测血清ＡＬＴ、ＨＢＶ感染标志和抗－ＨＣＶ。结果，发生输血后肝炎９例，发病率为１０．４６％，输血后乙型和丙型肝炎的发病率各为６．９７％和２．３２％，未定型为１．１６％；对照组无病发生。ＨＢＶ、ＨＣＶ感染以及ＡＬＴ异常与输血量有关。１０份ＨＢｓＡｇ阳性血输给１０名受血者，仅１例输入ＨＢｓＡｇ和ＨＢｅＡｇ双阳性血后ＨＢｓＡｇ阳转、ＡＬＴ异常。６份抗－ＨＢｃ阳性血的受血者，无异常反应，仅１例输入抗－ＨＢｃ和和ＨＢｅＡｇ双阳性血后，ＡＬＴ升高至５７单位，现有结果显示抗－ＨＢｃ阳性血未引起发病。３例抗－ＨＣＶ阳性血的受血者中，１例－ＨＣＶ阳转，但ＡＬＴ正常。     

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％。     

不同人群血中抗-HCV与HBsAg携带率的调查

我们于1992年7～10月间对不同人群的3328例血样作了抗-HCV和HBsAg的检测,结果发现农民献血员组抗-HCV阳性率达11.39％(234/2134),战士献血员273名全部阴性,临床病人为5.12％,健康查体者为0.7％,HBV及HCV重叠感染4组皆在0.5％以下,平均为0.18％。鉴于丙肝在我国已有局部流行,且抗-HCV携带率较高、具有传染性的现实,献血员应尽可能在丙肝低发区选择,且应作HBsAg及抗-HCV的筛选,减少输血后肝炎的发生。     

3857例患者输血前输血传播性疾病的检测

目的：调查受血者输血前传染病感染状况，探讨检测受血者输血前输血传播性疾病的必要性。方法：对3857例受血者输血前采用ELISA法检测血清乙型肝炎HBsAg、抗-HCV、抗-HIV．RPR法检测血清梅毒。结果；受血者中血清乙型肝炎HBsAg阳性者38例(0．985％)，抗-HCV阳性者22例(0．57％)，血清梅毒阳性者2例(0．57％)。结论：对受血者进行输血前传染病标志物指标检测是必要的，它不仅有利于患者的诊治，有利于医务人员的自我保护，也可以避免因输血而引起的医疗纠纷．     

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?     

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。     

安徽省合肥地区献血员的血清流行病学调查

用ELISA法检测1440名献血员的HAVIgA、ALT、抗-HCVIgG、HBVM、抗-EBVIgG、抗-CMVIgM及弓形体。结果显示：抗-HAVIgA阳性率为1．9％,抗-HCV阳性率为5．5％,其中职业和定期献血员抗-HCV阳性率为6．6％。抗-HCV阳性率与献血员的ALT、年龄和献血次数显著相关,且农村明显高于城市和郊区。HBsAg阳性率为1.5％,初次献血员HBsAg阳性率为3.3％,明显高于职业献血员。抗-HBcAg阳性率为3．2％,抗-HBe单项的阳性为1．2％。抗-CMVIgM阳性率为16．1％,抗-EBVIgA阳性率为1.6％,弓形体阳性率为0．3％。     

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。     

嘉兴地区无偿献血员血源性传染病监测分析

目的了解嘉兴地区无偿献血员中乙型肝炎表面抗原(HBsAg)、丙型肝炎抗体(抗-HCV)、丙氨酸氨基转移酶(ALT)、梅毒等4项传染病指标检测情况,在于进一步提高血液质量,预防和减少输血传播性疾病。方法用ELISA法检测HBsAg、抗-HCV,速率法检测ALT,RPR法检测梅毒。结果5750名无偿献血员中,不合格380名,不合格率为6．61％,其中检出阳性率抗-HCV为2．3l％,HBsAg为3、37％,ALT异常者4．45％,梅毒阳性者为0．54％。结论嘉兴地区献血员血源性疾病的感染率较低,但要加强秀州区和民工献血员的血源筛查工作。     

3029名受血者输血前4项检测结果分析

目的调查东莞厚街地区受血者输血前乙型肝炎病毒表面抗原(HBsAg)、抗艾滋病抗体(抗-HIV),丙型肝炎病毒抗体(抗-HCV)以及梅毒感染情况。方法 HBsAg、抗-HBV、抗-HCV采用酶联免疫法,梅毒采用TRUST及TPPA法,对3029例受血者进行检测。结果 HBsAg、抗-HIV、抗-HCV、梅毒、梅毒+HBsAg的阳性率分别为14.1%、0%、0.79%、1.09%、0.5%。结论应加强对受血者输血前血液传播疾病的检测。     

Risk of transfusion-transmitted hepatitis C virus in a tertiary hospital in Nigeria

OBJECTIVES: To evaluate the risk of probable iatrogenic hepatitis C virus (HCV) infection following transfusion of donor blood that has not been screened for HCV. STUDY DESIGN: Prospective study. METHODS: Screening for human immunodeficiency virus and hepatitis B virus is routine in the University of Benin Teaching Hospital. HCV screening was performed on transfused bags of donor blood selected at random. The detection of anti-HCV was based on the principle of double antigen sandwich immunoassay, in which purified recombinant antigens are employed sufficiently to identify anti-HCV. The outcomes of interest included the proportion of HCV-positive units of transfused donor blood, the source of blood and the total number of units of blood processed in the hospital blood bank. RESULTS: A total of 4532 units of donor blood were procured in the blood bank. Of these, 4132 units were certified as fit for transfusion following the hospital protocols. The sources of the transfused blood samples were commercial blood donors [89.2% (n = 3687)] and targeted donation [10.8% (n = 445)]. One hundred and ninety-two transfused blood samples were randomly screened for HCV, and 3% (n = 6) were found to be positive (95% confidence intervals 0.007-0.06). The likely risk of iatrogenic transfusion-related HCV infection was estimated to be 129 cases/year at the present rate of utilization of donor blood at the University of Benin Teaching Hospital. CONCLUSION: There is a risk of iatrogenic transfusion-transmitted HCV in the study hospital. Hospitals in Nigeria should screen for HCV prior to allogeneic transfusion, which may help in avoiding transfusion-related HCV and its probable long-term effects.     

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     

内窥镜检查、手术、输血前5969例患者HBV、HCV、HIV、梅毒螺旋体抗体检测结果

目的了解内蒙古医学院附属人民医院2006—2008年度内窥镜检查、手术、输血前患者HBV、HCV、HIV、梅毒螺旋体4种病原体的感染情况,为更好地预防和控制感染提供依据。方法对5969例患者血清采用ELISA检测乙型肝炎病毒血清标志物（HBVM）、丙型肝炎病毒抗体（抗-HCV）、艾滋病病毒抗体（抗-HIV）,采用甲苯胺红不加热血清试验TRUST及ELISA检测梅毒螺旋体抗体（抗-TP）。结果 5969例患者中,乙肝表面抗原（HBsAg）阳性患者144例,抗-HCV阳性患者65例,抗-HIV阳性患者末检出,抗-TP阳性患者9例。其阳性检出率分别为2.41%、1.09%、0、0.15%,其中孕妇HBsAg阳性7例,抗-HCV阳性2例。HCV感染率逐年上升,2008年与2006年相比较,存在显著性差异。254例内窥镜检查前患者传染性标志物的阳性检出率均较5715例手术、输血前患者的检出率高。HBVM模式中,HBsAg阳性组共检出6组,其中以HBsAg＋、HBeAg＋、抗-HBc＋及HBsAg＋、抗-HBe＋、抗-HBc＋两种模式为主,分别占13.19%、67.36%。结论为了使医院感染控制工作更加完善,在做好患者手术、输血前传染性标志物检测的同时,也应严格做好患者内窥镜检查前传染性标志物的检测,并且HBV感染的检测应由单一的HBsAg检测增为HBVM的检测,为临床预防和控制感染提供更全面、更可靠的依据。     

献血员人群HCV感染状况及其输血传播的调查

采用ELISA对1572份献血员血清进行抗HCV检测,阳性率为12.15％。其中女性献血员抗HCV阳性率较男性为高、单采浆献血员者较单纯献血全血者为高,抗HCV检测阳性率随献血员年龄增长而增高。近期ALT升高的单采浆献血者血清抗HCV阳性者显著地高于无近期ALT升高史的同类单采浆献血员。结果证实严格开展献血员HCV感染者筛选将有助于输血相关性的丙肝的预防。     

各型病毒性肝炎、肝癌抗－HCV检测及HCV感染与输血的关系

本文对各型病毒性肝炎、肝癌２００例进行血清抗－ＨＣＶ检测，阳性率为２０．５％，以重型肝炎和肝硬化检出率为高，分别为４２．８６％、４６．１５％，二者与其他型肝炎相比，有显著性差异（Ｐ＜０．０５）。输血后肝炎抗－ＨＣＶ阳性率为６７．５％，健康献血员抗－ＨＣＶ阳性率为２０．４７％，而输血后己型肝炎仅占２．５％。说明输血是造成丙型肝炎传播的重要途径，因此，对献血员应进行严格筛选。观察表明，ＨＢＶ与ＨＣＶ双重感染，可能是形成慢性肝炎，肝硬化以及促使肝炎向重型发展的重要原因之一。抗－ＨＣＶ阳性的慢性肝炎，血清ＡＬＴ５０％在正常范围内，余者仅轻度升高，说明ＨＣＶ感染所致的肝损伤可能是一个较慢的过程     

Risk factors associated with hepatitis C virus infection in Taiwanese government employees

This study evaluated the roles of multiple factors in hepatitis C virus (HCV) infection, with emphasis on the modification of various individual characteristics on the risk associated with percutaneous exposure to blood. Serum samples taken from 4869 men in Taiwan within a cohort study were tested for HCV antibody. The overall positive rate of anti-HCV was 1.6%. In a logistic regression, factors positively associated with anti-HCV positivity were previous blood transfusion (odds ratio [OR] = 7.28: 95% confidence interval [CI] = 4.26-12.45), a history of surgery (OR = 2.06: 95% CI = 1 23-3.46), and lower educational levels (OR = 1.94; 95% CI = 1.14-3.32). The anti-HCV positive rate was significantly lower in hepatitis B surface antigen (HBsAg) carriers than in non-carriers (OR = 0.60; 95% CI = 0.37-0.95). Ageing, lower educational levels, O blood group, and Taiwanese ethnicity enhanced the likelihood of HCV infection through blood transfusion/surgery, whereasHBsAg status, cigarette smoking, and habitual alcohol drinking reduced it.     

Common transfusion-transmitted infectious agents among thalassaemic children in Bangladesh

Transfusion-dependent children are more prone to acquiring various transfusion-transmitted infections (TTIs), such as hepatitis B (HBV), hepatitis C (HCV), HIV, and others. Since the magnitude of these infections among thalassaemic children in Bangladesh is not well-known, this study was conducted to assess the prevalence of TTIs among them (who received more than three blood transfusions) compared to their age- and sex-matched controls (non-thalassaemics and those who had never had a transfusion). Seromarkers for HBV, HCV, HDV, Treponema pallidum, and HIV were tested, and the results were analyzed using SPSS/Windows 10.5. Of 259 children studied, 152 (58.69%) were thalassaemic (mean age 6.8 +/- 3.6 years), and 107 were controls (mean age 6.7 +/- 3.53 years). The HBV and HCV-markers were found significantly more often among multi-transfused thalassaemic children than among the controls in terms of HBsAg (13.8% vs 6.5%, p < 0.04), anti-HBc total (39.5% vs 9.4%, p < 0.0001), and anti-HCV (12.5% vs 0.9%, p < 0.0001). HBeAg did not differ (p = 0.82) between the thalassaemics (9.52%) and the controls (14.28%), whereas anti-HBe differed (0% vs 57.14%, p < 0.003). Neither the thalassaemics nor the controls were positive for HDV, HIV, or T. pallidum. Since more thalassaemic children acquired hepatitis B and C infections through multiple blood transfusions, it is recommended that the safe blood-transfusion programme be strengthened and mass vaccination against HBV (even who suffer from HCV) in Bangladesh be undertaken.     

各型病毒性肝炎、肝癌抗—HCV检测及HCV感染与输血的关系

本文对各型病毒性肝炎、肝癌２００例进行血清抗－ＨＶＣ检测，阳性率为２０．５％，以重型肝炎和肝硬化检出率为高，分别为４２．８６５、４６．１５％，二者与其他型肝炎相比，有显著性差异（Ｐ＜０．０５）。输血后肝炎抗－ＨＣＶ阳性率为６７．５％，健康献血员抗－ＨＣＶ阳性率为２０．４７％，而输血后乙型肝炎仅占２．５％。说明输血是造成丙型肝炎传播的重要途径，因此，对献血员应进行严格筛选。观察表明，ＨＢＶ与ＨＣＶ双