无偿献血血液不同筛查模式应用效果研究

目的评价临床用血血样不同筛查模式的应用效果，以降低无偿献血血液报废率，提高临床输血安全性。方法对不同时期临床用血采用不同传染性救病筛查模式进行筛查，并考核其安全性。结果自1997年开始，按照国家规定，临床用血安全性筛查项目包括HbsA异、抗-HCV、ALT、梅毒和抗-HIV。1997年检测个体卖血血样3442份，报废血样3份，报废率为0．08％。无偿献血血样28650份，报废血样4077份，报废率为14．23％；1998～2002年检测无偿献血血样206948份，报废血样12479份，报废率下降到6．03％：2003年检测无偿献血血样44529份，报废血样1465份，报废率再次下降到3．29％；2004年起对16592例无偿献血HBsA异、抗-HCV、抗-HIV ELISA方法检测阴性的标本进行PCR法复检，重新发现HBsA异阳性标本8例，为0．048％。结论对无偿献血者采血前进行快速筛查，能有效降低无偿献血的报废率，提高临床用血安全性，减少临床用血安全事故发生。     

血液检测方法对控制输血风险残余度的影响

目的 探讨献血者血液病毒标志物检测中试剂及检测方法的选择对输血风险残余度的影响.方法 对成品血液随机进行艾滋病抗体(抗-HIV)、丙肝抗体(抗-HCV)及乙肝表面抗原(HBsAg)测定 ,共9236份,同时使用聚合酶链反应(PCR)对其中500份HBsAg阴性的标本进行HBV DNA检测及进行HBV标志物其他四项指标的检测.结果 再检测结果不符率:抗HIV为0,抗HCV为0.37%,HBsAg为0.42%,有显著性差异(P<0.005);500份HBsAg阴性的标本中PCR测定HBV DNA阳性率为2.8%,HBV标志物其他四项指标(HBeAg、HBeAb、HBsAb、HBcAb)中阳性率为1%,HBV DNA定量在104～106cp/ml.结论 要有效控制输血风险残余度,建立专门的试剂质量评估方法并提高试剂质量标准,随着科学技术的发展,将成熟的检测技术(如PCR)尽快用于实际检测.     

HIV血液筛选试剂的评价

目的：选择一组优质、高效和实用的HIV ELISA血液筛选试剂组合。方法：采用4种不同厂家的HIV ELISA试剂（其中两种国产试剂，两种进口试剂）分别对国家参比品、卫生部质控制品和无偿献血者标本进行检测，分析比较4种试剂的符合率、阳性检出率、假阳性率、最低检测限、稳定性和前带效应。结果：4种试剂的符合率均达到国家要求；阳性检出率均为0．01％；国产试剂的假阳性率高于进口试剂，最低检测限低于进口试剂；C试剂的稳定性最优，也不存在前带效应。结论：本文提示采用B和C组合进行HIV血液筛选效果较好。     

血站ELISA法筛查HIV抗体阳性标本与免疫印迹法检测结果的比较

目的 比较血站ELISA法筛查HIV抗体阳性标本与免疫印迹法确认的结果.方法 对HIV抗体初筛阳性标本采用免疫印迹试验进行确证.结果 ELISA 法与免疫印迹法的阳性符合率为85.4%.S/CO值大于或等于1而小于6,与确证试验阳性符合率为25.0%;大于或等于4而小于10,阳性符合率为73.7%;S/CO值大于或等于10,阳性符合率为92.3%.结论 筛查试验存在一定假阳性结果,随着s/co值的增高,与确证试验的阳性符合率也升高.由于ELISA初筛试验存在假阳性结果,HIV抗体结果报告必须以WB结果为准.     

Computer-based interview for screening blood donors for risk of HIV transmission.

OBJECTIVE--To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors and to determine donor reactions to the use of the interview. DESIGN--A comparison of the rate of detection of HIV-related factors elicited by a computer interview with that obtained by standard American Red Cross procedures for assessment of donor suitability, including a randomized crossover trial in which the order of the two methods was reversed. Information obtained by the computer was not available to influence the use of blood components for transfusion. SETTING--The computer interview was administered to donors at an American Red Cross blood donor center and at a mobile blood drive at a hospital. SUBJECTS--Consecutive sample of 294 male and female blood donors 18 to 75 years of age. MAIN OUTCOME MEASURES--Subjects' responses to the computer-based interview as well as responses to the standard Red Cross written questionnaires and face-to-face interviews were used for donor assessment. RESULTS--The interview took an average of 8 minutes to complete. From among 272 donors who provided complete data, the computer identified 12 donors who reported either behaviors associated with a risk of HIV acquisition or symptoms compatible with the acquired immunodeficiency syndrome; none of these donors had been so identified either by routine written questionnaires or by face-to-face interviews used to screen potential blood donors. Only one of the 12 identified donors used the confidential unit exclusion procedure to prevent use of his donated unit. The rate of elicitation of HIV-related factors by the computer interview was 12 (4.4%) of 272 (95% confidence interval [CI], 2.3% to 7.6%), compared with two (0.13%) of 1536 (95% confidence upper bound, 0.28%) using the standard Red Cross procedure (P less than .0001). Tests for antibodies to HIV were negative in blood samples from all of the 272 subjects studied. The subjects enjoyed the computer interview and judged it to be more private than the standard donor assessment method. They also predicted that donors would be more honest with the computer interview than with a human interviewer. CONCLUSIONS--Computer-based screening elicits more HIV-related factors in the health histories of blood donors than do the standard questionnaire and interviewing methods currently in use. Computer-based screening is also acceptable to blood donors.     

Two-phase test of fecal occult blood screening for colorectal cancer

The detection of colorectal cancer in an early curable stage has become the focus of considerable interest recently. A two-phase test using both guaiac test and Hemolex latex immuno-agglutination test was applied for fecal occult blood screening of colorectal cancer. A total of 4,725 veterans aging 60 to 69 years were registered, and 2,176 persons (average age 66 years) completed the test giving a compliance rate of 46%. The positive rates of both tests were accounted 20.5% and 6.7% respectively. Five hundred and forty five persons had positive reaction for at least one of the tests. Of these, 90 had a follow up diagnosis with colonoscopy or combined with barium enema. Three rectal adenocarcinomas were detected, of which only one was positive by guaiac test, but two by Hemolex test. A rectal carcinoid was found by rectodigital examination. It was negative by both tests. Nineteen cases were detected to have one or more polyps in colon or rectum, of which only 6 were positive by guaiac test, but 18 by Hemolex test. Hemolex test using antibody against human hemoglobin is based on latex agglutination reaction. It is more sensitive and specific than guaiac test. Moreover, no dietary restriction is required. In the view point of cost-effectiveness, mass screening for colorectal cancer in general public is not recommended, but hospital-based screening for high risk group is still worthwhile to study.     

无偿献血血液检测现况研究

目的了解无偿献血人群的一般特征,为加强献血者招募的质量控制提供依据。方法收集2008年1月～2010年12月,到我中心采血点无偿献血的38974名无偿献血者资料,内容包括年龄、性别、职业及血液质量各项指标的检测结果(ALT、HBsAg、梅毒抗体、抗HIV、抗HCV)。分析各项指标的阳性率与年龄、性别、职业的关系。结果不同年龄组及不同性别献血者之间HBsAg阳性率的差异具有统计学意义,其余各项指标在年龄组间及不同性别间均无差异。不同职业间各项血液指标阳性率的差异具有统计学意义,工人的各项指标阳性率均较高,而军人及专业技术人员的各项指标阳性率均较低。结论职业应当作为今后招募固定献血者的重要限制因素,青年军人、专业技术人员、学生应当作为重要的招募对象人群,同时还应加强对军人及专业技术人员献血相关信息的宣传。     

What happens to donated blood?

Pursuing their chief work--gathering, processing and distributing blood--the blood donor centres of the Canadian Red Cross Society follow standard operating procedures like those in place at the Ottawa centre. Here, recruitment staff and volunteers work to recruit donors to meet needs at a time when the number of donors is falling. When they register, donors must show proof of identity. Each receives a permanent identification number that is linked to the numbers assigned to the units of blood each donates and to the date the unit was collected and the centre that collected it. Donors must answer questions about health and high-risk activity, and the blood of those who report high-risk activity is not accepted. Units are screened by automated instruments for syphilis, hepatitis B and C, HIV types 1 and 2, and human T-cell leukemia virus. Units with a negative test result are broken down into components for use in hospitals. A reactive test result prompts quarantining of the unit and a second screening test. If this test result is also reactive, a sample of the unit is sent to the National Testing Laboratory for confirmatory testing, and the unit is discarded. Once it has the results of the confirmatory test, the centre contacts the donor. Blood is now considered a drug. Red Cross practices in Canada and around the world have been changing since 1989 to reflect this.     

基于HIV检测分析对无偿献血人群HIV筛查策略及归队的探讨

目的 对陕西省域内无偿献血者进行人类免疫缺陷病毒（human immunodeficiency virus,HIV）检测,分析省域内无偿献血人群HIV流行情况,以期为制定适宜的血液筛查策略和献血者归队方法提供数据与理论依据。方法 选定有区域代表性的陕西省西安市、延安市与安康市3家中心血站的无偿献血者血液样本进行2种四代酶联免疫吸附试验（enzyme-linked immunosorbent assay,ELISA）和病毒核酸检测（nucleic acid testing,NAT）HIV,将所有检测呈反应性的样本进行确证试验。结果 对290 341例无偿献血者进行HIV筛查,总计352例初检结果为不合格（含1例ELISA-/NAT+有反应性）,筛查反应率0.12%;所有样本送至属地市疾控中心检测,最终确证阳性11例（含核酸检测阳性1例）,确证阳性符合率3.79/10万。结论 陕西省域内无偿献血者中HIV阳性符合率低,提示目前无偿献血者HIV的血液筛查策略有待改进,同时也为献血者归队提供一定的理论支持。     

快速微血管全血糖测定在妊娠期糖尿病筛查中的应用

目的探讨快速微血管全血糖(CBG)测定是否与静脉血浆糖(VPG)一样,可应用于门诊妊娠期糖尿病(GDM)筛查。方法选取行产前检查及分娩的1 557例孕妇为研究对象,采用美国国家糖尿病资料组(NDDG)推荐的方法进行GDM筛查。每例孕妇于孕24~28周时取肘静脉血进行VPG测定;同时在同一侧手指末端采取微血管血一滴行CBG测定,作为自身对照。分别以随机选择的340例行口服葡萄糖耐量试验(OGTT)的孕妇所诊断的GDM及筛查试验VPG≥7.8 mmol/L作为金标准,比较两种测定结果与CBG临界值的差异。结果VPG和CBG有很好的相关性(P<0.01),CBG值略低于VPG值,VPG与CBG的受试者工作特征曲线下面积无统计学差异(P>0.05)。以OGTT诊断的GDM作为金标准时,CBG的阈值为7.4 mmol/L,VPG的临界值为7.8 mmol/L;以VPG≥7.8 mmol/L作为金标准时,CBG的阈值为7.0 mmol/L。三种诊断标准的围生结局无统计学差异(P>0.05)。结论CBG测定可用于门诊GDM筛查,与VPG测定有很好的一致性,其阳性诊断值较VPG略低;该方法具有微创、方便、快捷的优点。     

快速微血管全血糖测定在妊娠期糖尿病筛查中的应用

目的 探讨快速微血管全血糖(CBG)测定是否与静脉血浆糖(VPG)一样,可应用于门诊妊娠期糖尿病(GDM)筛查. 方法 选取行产前检查及分娩的1 557例孕妇为研究对象,采用美国国家糖尿病资料组(NDDG)推荐的方法进行GDM筛查.每例孕妇于孕24～28周时取肘静脉血进行VPG测定;同时在同一侧手指末端采取微血管血一滴行CBG测定,作为自身对照.分别以随机选择的340例行口服葡萄糖耐量试验(OGTT)的孕妇所诊断的GDM及筛查试验VPG≥7.8 mmol/L作为金标准,比较两种测定结果与CBG临界值的差异. 结果 VPG和CBG有很好的相关性 (P＜0.01),CBG值略低于VPG值,VPG与CBG的受试者工作特征曲线下面积无统计学差异(P＞0.05).以OGTT诊断的GDM作为金标准时,CBG的阈值为7.4 mmol/L,VPG的临界值为7.8 mmol/L;以VPG≥7.8 mmol/L作为金标准时,CBG的阈值为7.0 mmol/L.三种诊断标准的围生结局无统计学差异(P＞0.05). 结论 CBG测定可用于门诊GDM筛查,与VPG测定有很好的一致性,其阳性诊断值较VPG略低;该方法具有微创、方便、快捷的优点.     

血站HIV核酸检测反应性作为HIV补充试验的可行性验证

目的 探讨血站血液筛查工作中,HIV核酸检测(HIV nucleic acid test,HIV NAT)反应性是否可代替免疫印迹法(western blotting,WB)抗体确证试验作为HIV酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)筛查方法的确证依据.方法 选取2010年11月至2012年12月北京市红十字血液中心无偿献血者HIV ELISA筛查不合格的标本641份,比较其HIV NAT结果与疾病预防控制中心(Center for Disease Control and Prevention,CDC)判定的WB结果,并对HIV NAT反应性但WB不确定或阴性的献血者分析其CDC随访的WB检测结果.结果 641份标本中,219份(34.2％)HIV NAT结果为反应性,其中WB确证结果为阳性206份,WB不确定13份,WB阴性0份.对13份ELISA不合格HIV NAT反应性WB结果不确定的标本经北京市CDC随访成功7份,WB均转为阳性;其余6份HIV NAT和WB条带结果支持HIV早期感染,且依据2019版《艾滋病和艾滋病病毒感染诊断标准》判定为WB阳性.因此219份HIV NAT反应性的HIV ELISA筛查不合格献血者均为HIV感染者.结论 对采用HIV ELISA双试剂和HIV核酸并行检测程序的采供血机构,对于HIV NAT反应性的HIV ELISA筛查不合格的献血者,可考虑直接上报为HIV确证阳性;对于HIV NAT非反应性的HIV ELISA筛查不合格的标本则送CDC参照临床诊断检测策略进行确证,可助于缩短HIV阳性献血者的确证时间.     

庆阳市无偿献血者HIV筛查及确证分析研究

目的:研究分析庆阳市无偿献血者HIV筛查中应用酶联免疫吸附试验(ELISA)和核酸检测(NAT)的现状及送检确诊感染情况。方法:回顾调查庆阳市70 659人次无偿献血者HIV项目酶免检测、核酸检测及送检确证HIV感染情况。结果:70 659人份无偿献血者样本中,HIV酶免检测阳性样本133人份,HIV酶免检测阳性率为0.188%;在酶免HIV阴性的样中,未检测出核酸HIV阳性的样本,送检确证HIV阳性样本16人份,确证阳性率0.0226%,庆阳市无偿献血者HIV感染率相对较低,但近年来有逐年递增的趋势。结论:庆阳市无偿献血者HIV筛查中应用ELISA与NAT相结合,能减少潜在输血风险;对送检确证HIV感染人群的特征分析研究,为制定庆阳市艾滋病防治措施和血液质量安全提供了可靠的理论依据。