重庆地区无偿献血人群丙型肝炎病毒流行病学调查

目的研究重庆地区无偿献血人群的丙型肝炎感染率及流行特征.方法收集从2003年6月～2004年5月共13 620名健康志愿献血者血液,检测丙型肝炎病毒抗体、RNA以及基因分布和序列特征.丙肝病毒抗体采用ELISA,阳性标本进一步采用反转录聚合酶链反应（RT-PCR）扩增5′-非翻译区（5′-UTR）和核心区（Core）片断.病毒基因分型根据核心区序列进行,PCR扩增产物直接用于测序并分型.结果在所有13 620份志愿献血者标本中经ELISA试剂盒共检出67例丙肝抗体阳性,丙肝抗体阳性率为0.49%, 不同年龄组从0.27%～0.86%不等,不同性别间和婚否间无明显差异.对34份抗体阳性标本进一步分析,共扩增出24份5′-UTR阳性,病毒RNA血症阳性率为71%;共有22份标本成功扩增核心区片断并测序和基因分型,基因型1b占4份（18%）,基因型2a占5份（23%）,基因型3a占9份（41%）,基因型3b占4份（18%）.基因型3a为主要流行株.结论重庆地区志愿献血人群丙肝感染率较低,有基因型1b、2a、3a和3b,以基因型3a为主要流行株.     

Infections transmitted from donors to recipients following organ transplantation

There is an ever-increasing gap between the number of donors and those waiting for organ grafts, resulting in increased waiting times and mortality on transplant waiting lists. Consequently, every potential donor must be considered for possible transplantation even if they are outside the conventional donor criteria. To address this imbalance, organs are currently transplanted from living donors, older donors, haemodynamically unstable and non-heart-beating donors, and donors with prior infections. There is a potential to transmit infections and, to a lesser extent, malignancy from the donor organ to the immunosuppressed recipient, and this may also have an effect on subsequent organ function in the recipient. Thus, transmission of infections from organ donors to recipients represents low but serious potential risks that must be weighed against a candidate's risk of dying before a transplant becomes available.     

器官移植受者巨细胞病毒感染检测的临床意义

目的探讨器官移植受者巨细胞病毒感染早期、快速、准确的检测方法。方法采用核酸基础序列扩增法（nucleic acid sequence—based amplification，NASBA法）检测器官移植受者巨细胞病毒即刻早期信使核糖核酸（immediate—early，IE—mRNA）以及晚期信使核糖核酸（pp67-mRNA），同时行抗原血症（pp65）的检测，并将结果相比较。结果42例器官移植受者中发生有症状的活动性巨细胞病毒感染者（CMV病）共11例，其中IE—mRNA阳性10例，pp67-mRNA阳性6例，pp65抗原阳性（≥1个／5万WBC）8例。IE—mR．NA的敏感度、特异度、阳性预测值和阴性预测值分别为90．9％、80．6％、62．5％和96．1％。结论器官移植术后应用NASBA法检测巨细胞病毒IE—mR．NA具有早期、快速、特异的优点，为临床指导抗病毒治疗提供了较客观的依据。     

美国静脉注射吸毒者的HCV负载及存活率

慢性丙型肝炎病毒（HCV）感染，有时可同时感染HIV和人T淋巴细胞病毒Ⅱ型（HTLV—Ⅱ），其发展为终末期肝病（ESLD）的风险性很高。作在1987—1991年间，对美国9个城市的6750例静脉注射吸毒中伴或不伴有HIV／HTLV—Ⅱ协同感染的HCV患，评估ESLD死亡是否与发病前的HCV—RNA水平或特异性HCV蛋白抗体有关。作对比了84例ESLD后代和305例随机选择的可检测出HCV—RNA的参加，根据性别、种族、HIV和HTLV—Ⅱ分层。ESLD死亡的相对风险度（RH）可从比例风险模型中获到。分别或联合考虑，ESLD死亡风险与抗HCV c-22（P）、c-33（P）、c-100（P）及NS5蛋白的抗体浓度无关，但是它会随着HCV—RNA水平的增加而增加（校正后每log10U／ml为RH2．26，95％CI 1．45～5．92）。在校正乙醇消耗后，HCV—RNA水平和ESLD死亡的关系仍是显的（校正后每log10U／ml为RH2．57，95％CI1．50～8．10）。因AIDS死亡（n=45）和其他原因发生的死亡（n=43）与HCV—RNA无关（各自校正后每log10U／ml的RH分别为1．14和1．29）。校正HCV—RNA后，多变量分析显示HIV感染和ESLD风险无关。     

肝移植受者术后生存体验的质性研究

目的 了解肝移植受者术后的生存体验.方法 采用质性研究的现象学研究法,对17例肝移植受者进行面对面、半结构式的深入访谈,并运用Colaizzi法分析资料,提取有价值的资料和观点,并提炼主题.结果 肝移植受者对生存质量的主观体验各不相同,但普遍认为肝移植手术提高了生存质量.生存质量的5个层面14个主题被提炼,①主观体验层面:包括提高生活自由度、豁达的生活态度和提高生活信心3个主题;②生理层面:包括患者体能改变、性生活意愿下降或改善和睡眠质量改善3个主题;③心理层面:担忧、自卑和感恩心理3个主题;④社会和家庭层面:社会交往圈改变、较完善的社会支持系统和良好的家庭支持3个主题;⑤自我护理能力:注重自我保护避免感染和遵医行为的差异性2个主题.结论 肝移植手术为肝病患者提供了生存机会,提高了他们术后的生活质量.医务人员应注重肝移植受者在生理、心理、社会适应能力及自我护理方面的体验,采取多种护理措施为患者提供指导与帮助,提高其生活质量.     

Hepatitis C virus RNA (HCV-RNA) in blood donors and family members seropositive for anti-HCV antibodies

BACKGROUND: Non-A, non-B virus is responsible for 75-90% of all cases of blood transfusion-related hepatitis. The aim of this work was to determine hepatitis C virus RNA (HCV-RNA) in a group of blood donors and their household contacts. Serotype and genotype of the isolates were also studied. METHODS: HCV antibodies were investigated in 44,588 blood donors with a commercial immunoassay. Forty-four seropositive donors and 72 household members were further studied. Quantitative analysis of viral RNA was performed with Amplicor HCV 2.0 test, while genotype was determined by INNO-LiPA test and serotype with Murex HCV test. RESULTS: Among the 44,588 donors studied, 333 (0.74%) were positive for anti-HCV. Viral RNA was found in 35 (80%) of the 44 seropositive cases studied. Among the 72 household members, HCV antibodies were detected in six (8.3%) and HCV-RNA in four of these individuals. Serotype 1 and genotype 1 were the most frequent types detected (48 and 64%, respectively). The genotype in the blood donor matched that of his seropositive family member in four of six cases. CONCLUSIONS: Our results suggest that intrafamilial transmission of HCV may occur and we stress the need to study household members of seropositive blood donors, as they have a high risk of infection. In this community, genotype 1 is the most prevalent type in blood donors and family members.     

肾移植受者BK病毒感染的临床诊断

目的 探讨肾移植受者BK病毒感染的诊断方法、监测指标.方法 采集234例肾移植受者的血、尿样本,行BKV尿沉渣细胞学计数与实时荧光定量PCR检测方法.结果 234例受者的尿Decoy细胞、BK病毒尿症与病毒血症的阳性率分别为33.3%、33.3%和16.2%.尿Decoy细胞阳性者Decoy细胞中位数水平为6个/10HPF,BKV DNA阳性者尿液和外周血BKV中位数水平分别为7.62×103 copy/ml和7.61×103 copy/ml.尿液BKV阳性率较外周血明显升高(P=0.000).尿液Decoy细胞计数与尿液BKV含量相关(γ=0.59,P=0.000),但尿液和外周血中BKV含量无明显相关性(P=0.14).结论 肾移植受者易发生BKV再活化,定量尿沉渣细胞学检测简单、易行、敏感,可以做为BKV活化的指标,间接反映肾脏病理情况,也可检测血、尿BKV DNA了解病毒活化情况、筛查BKV相关的移植肾肾病.     

实体器官移植受者侵袭性真菌病的诊治近况

随着移植技术的成熟,实体器官移植(solid organ transplant,SOT)成功率显著提高。近年来,在SOT受者中侵袭性真菌病(invasive fungal disease,IFD)的发生率呈逐年上升趋势,其病死率较高,已成为SOT受者移植物带功能死亡的重要原因。由于IFD对移植成功造成极大威胁,已引起临床移植医师的高度重视。IFD治疗能否成功,取决于对IFD的早期诊断和及时有效治疗,目前相关研究多基于病例报道或回顾性分析。本文对侵袭性真菌病的危险因素、发病率、诊断及治疗进展作一综述。     

Hepatitis B surface antigenemia in renal transplant recipients. Increased mortality risk.

To determine effects of circulating hepatitis B surface antigen (HBsAg) on patient survival following renal transplantation, we studied 168 recipients of cadaveric grafts in whom HBsAg status was defined at transplantation by comparison of survivorships determined by actuarial life-table methods. Survival in HBsAg-positive recipients, as compared with those who were HBsAg-negative at the time of transplantation, was markedly diminished. Although graft survival appeared to be favored in the HBsAg-positive group in the early posttransplant period, the apparent protective effect was lost at nine months after grafting and thereafter, due to increased mortality in the HBsAg-positive recipients. Deaths in the antigenemic subjects were principally due to infections other than hepatitis and to cardiovascular events. We conclude that preexisting HBs antigenemia forebodes an ominous outcome for immunosuppressed renal transplant recipients, although hepatic disorders do not account for most deaths.     

湖北省部分地区经血途径感染艾滋病人群中丙型肝炎病毒基因型分布

目的了解湖北省经血途径感染HIV-1人群中合并HCV感染情况及HCV基因型分布。方法2004年7月至2010年12月间在本院诊治或会诊的597例抗HIV阳性者进行HCV筛查,并行HCV病毒载量检测,对HCVRNA阳性者进行逆转录巢式聚合酶链反应扩增HCV核心基因区,并对扩增产物进行测序,采用Mega软件对所得序列进行基因树分析。结果既往有偿供血和受血的HIV感染者中HCV的感染率分别为76．5％（205／268）,57．4％（189／329）。97例HIV、HCV合并感染者行HCV基因分型检测,发现1b型90例（92．8％）和2a型7例（7．2％）,两型的HCV病毒载量（HCV—VL）差别无统计学意义[对数值分别为（6．0±1．0）拷贝／ml、（5．8±1．4）拷贝／ml,t=0．40,P=0．69]。结论血液途径为HIV、HCV合并感染的主要途径。受血感染者合并HCV感染率低于献血人群,感染者中HCV的基因型主要为1b型和2a型。     

肾移植受者BK病毒感染的临床诊断及治疗

目的 探讨肾移植受者BK病毒(BKV)感染的诊断及治疗方法.方法 选取肾移植术后48个月内的患者共227例.采集其血、尿样本,行BKV尿沉渣细胞学计数与实时荧光定量PCR检测病毒拷贝.对部分肾移植受者进行移植肾活检.将尿或血中BKV DNA阳性患者80例分成干预组(51例)与对照组(29例).干预组进行调整免疫抑制剂:19例环孢素A(CsA)减量,22例他克莫司(FK506)减量,10例FK506转换成CsA;对照组不进行干预,并且密切监测急性排斥反应.干预3个月后再次检测,比较组内和组间干预前后BKV活化指标的差异.结果 227例受者的尿decoy细胞、BK病毒尿症与病毒血症的阳性率分别为33.O%、33.5%和15.4%.干预组干预后尿decoy细胞、尿和血BKV数量的中位水平均为O,明显低于干预前(5.0个/10HP,1.50 x 104拷贝/ml,0拷贝/ml,均P<0.01).对照组观察前后尿decoy细胞、血BKV数量的中位水平差异无统计学意义(6.0个/10HPvs 5.0个/10HP、0拷贝/ml vs 0拷贝/ml,均P>0.05),尿BKV数量观察结束时上升(观察前:0.79×104拷贝/ml,观察后:2.21 x104拷贝/ml,P<0.01).上述各项指标干预前后的差值在干预组与对照组间差异均有统计学意义(均P<0.05).干预过程中所有患者均未出现急性排斥反应.确诊BKV相关性肾病4例,其干预治疗后尿decoy细胞计数以及血、尿BKV DNA均明显降低,移植肾功能有所恢复.结论 定量尿沉渣细胞学检测简单、易行、敏感,可以作为BKV活化的指标,间接反映肾脏病理情况.也可检测血、尿BKV DNA了解病毒活化情况、筛查BKV相关的移植肾肾病.减少免疫抑制剂剂量或换FKS06为CsA治疗肾移植术后BKV感染效果良好.     

A study of Hepatitis A and E virus seropositivity profile amongst young healthy adults in India

Background

Various Serosurveys and studies provide ample evidence of differing perspectives regarding epidemiology of HAV and HEV in India. This study was conducted to assess the seroprevalence of HAV and HEV and its associated factors with an aim to provide inputs to planners regarding requirement of HAV vaccine.

Methods

A multi-centric cross sectional survey amongst 4175 healthy trainees (young adults) was carried out in training centres, selected by multistage random sampling, giving equal representation to all regions of India. Sample size was calculated by taking prevalence of HAV seropositivity amongst adults as 60% and alpha 0.05.

Results

Seroprevalence for HAV and HEV was 92.68% (95% CI 91.82, 93.47) and 17.05% (15.90, 18.26), respectively. Logistic regression showed that hand washing without soap, regular close contact with domestic animals, consumption of unpasteurized milk and regular consumption of food outside home were risk factors for HAV (p < 0.05). For HEV, irregular hand washing, consumption of unpasteurized milk and irregular consumption of freshly prepared food were risk factors (p < 0.05).

Conclusion

High level of immunity against HAV among the healthy young adults clearly demonstrates that vaccination against HAV is not required at present in our country. The large proportion being susceptible to HEV points towards the requirement of preventive strategies in the form of safe drinking water supply, hygiene, sanitation, increasing awareness and behaviour change with respect to personal hygiene especially hand and food hygiene.     

A study of Hepatitis A and E virus seropositivity profile amongst young healthy adults in India

Background

Various Serosurveys and studies provide ample evidence of differing perspectives regarding epidemiology of HAV and HEV in India. This study was conducted to assess the seroprevalence of HAV and HEV and its associated factors with an aim to provide inputs to planners regarding requirement of HAV vaccine.

Methods

A multi-centric cross sectional survey amongst 4175 healthy trainees (young adults) was carried out in training centres, selected by multistage random sampling, giving equal representation to all regions of India. Sample size was calculated by taking prevalence of HAV seropositivity amongst adults as 60% and alpha 0.05.

Results

Seroprevalence for HAV and HEV was 92.68% (95% CI 91.82, 93.47) and 17.05% (15.90, 18.26), respectively. Logistic regression showed that hand washing without soap, regular close contact with domestic animals, consumption of unpasteurized milk and regular consumption of food outside home were risk factors for HAV (p < 0.05). For HEV, irregular hand washing, consumption of unpasteurized milk and irregular consumption of freshly prepared food were risk factors (p < 0.05).

Conclusion

High level of immunity against HAV among the healthy young adults clearly demonstrates that vaccination against HAV is not required at present in our country. The large proportion being susceptible to HEV points towards the requirement of preventive strategies in the form of safe drinking water supply, hygiene, sanitation, increasing awareness and behaviour change with respect to personal hygiene especially hand and food hygiene.     

Hepatitis C virus in intravenous drug users

Sera from 172 intravenous drug users were tested for the presence of antibodies to hepatitis C virus (anti-HCV). The results were analysed in relation to aspects of the history of drug use and evidence of liver disease. The presence of anti-HCV was strongly associated with duration of intravenous drug use. Two-thirds of patients were anti-HCV seropositive within two years of commencing regular intravenous drug use, and there was 100% seropositivity among people injecting drugs for more than eight years. Seropositivity for hepatitis C virus closely paralleled exposure to hepatitis B virus, which was also endemic in this population. In contrast, only one patient tested positive for antibodies to the human immunodeficiency virus. The presence of anti-HCV correlated poorly with biochemical markers of hepatitis. About half the patients with anti-HCV had normal serum levels of alanine aminotransferase, whereas an abnormal liver biochemistry was frequently observed in anti-HCV seronegative subjects. Previous studies of non-A, non-B hepatitis that have used abnormal liver biochemistry as a marker have underestimated the prevalence of chronic hepatitis among intravenous drug users; the use of a specific screening test reveals that infection with hepatitis C virus is very common in this population.     

Hepatitis C virus genotypes in Saudi Arabia

Hepatitis C virus genotypes have been associated with specific geographical areas and in many cases with specific mode of transmission. In developed countries, genotype determination has formed a part of the management of patients with hepatitis C virus seropositivity and liver diseases due to hepatitis C virus. The epidemiology of hepatitis C virus has been shown to be changing rapidly in many countries due to population movement and different life-styles; hence the distribution of the genotypes is being monitored closely in many countries. In the Kingdom of Saudi Arabia, there are only a handful of publications recording the hepatitis C virus genotypes in various population groups. These studies have been carried out mainly in Riyadh (Central province) and Jeddah (Western province). There are no studies emanating from the Eastern or Northern provinces. According to these studies, the most prevalent genotype in the Western Province and probably in the whole Kingdom of Saudi Arabia was genotype 4, followed by genotypes 1a and 1b. Genotypes 1, 2a,/2b, 3 and 6 are very rare in the Kingdom of Saudi Arabia. Genotype 5 was identified exclusively in the Western province and nowhere else. Genotypes 1b and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. More detailed epidemiological studies of hepatitis C virus infections are needed in the Kingdom of Saudi Arabia to gain more insight into a possible type/subtype-specific pathogenesis of hepatitis C virus in the different regions of the Kingdom of Saudi Arabia as well as the distribution of the genotypes in the various localities.