输血后丙型肝炎前瞻性调查

１９９０－１９９１年在河北省甲乙两县用前瞻性方法调查了输血后肝炎、甲县献血员在献血前筛查ＡＬＴ和ＨＢｓＡｇ，观察了６４名受血者；乙县献血员献血前不筛查任何指标，观察了９０名受血者。结果输血后肝炎发生率，甲县为２１．９％，乙县为４４．４％；输血后抗－ＨＣＶ阳转率分别为１８．８％和４５．６％；其中输血后丙型肝炎分别为１４．１％和４１．１％。ＡＬＴ首次异常距输血平均时间，甲县为５１．９±２０。９天，乙县为４８．２±１６．８天，抗－ＨＣＶ阳性受血者为３５．９±１７．９天。抗－ＨＣＶ阳转距输血平均时间，甲县４２．４±１５．９天，乙县３８．４±１１．８天。输入抗，ＨＣＶ阳性或阴性血的受血者，ＨＣＶ总感染率分别为８８．２％（４５／５１）和７．８％（８／１０３），其中输血后丙型肝炎发生率分别为７８．４％（４０／５１）和５．８％（６／１０３）。既往ＨＣＶ隐性感染者输血后丙型肝炎发生率为５２．４％（１１／２１）。     

简要快讯

母亲及其子女干血斑标本中检测丙肝抗体［英］／Ｐａｒｋｅｒｐｐ…／／Ｊ Ｃｌｉｎ Ｍｉｃｒｏｂｉｏｌ－１９９９,３７（６）．－２０６１～２０６３ 作者从巴基斯坦两个医院的产妇科和小儿科获得母子干血斑标本,用第３代ＨＣＶ免疫印迹法试剂盒检测其中的ＨＣＶ抗体．结果在４１７例母亲的干血斑中ＨＣＶ阳性率为６．７％,而５３８例子女的阳性论为 １．３％,其中有 ４例抗ＨＣＶ ＩｇＧ（＋）儿童的母亲血中抗ＨＣＶ ＩｇＧ则是阴性的。从而提示这４例儿童的ＨＣＶ感染是从社会中获得的。 （朱德钟摘）免疫层析试验快通诊断腺病毒呼…     

肝癌患者庚型肝炎病毒感染血清学研究

采用抗－ＨＧＶ酶联免疫试验（ＥＩＡ）对１６０例肝细胞癌（ＨＣＣ）和１３０人健康人群进行了检测，结果抗－ＨＧＶ阳性率分别为１４．３８％和２．３１％，表明在不同人群中存在庚型肝炎病毒（ＨＧＶ）感染；ＨＣＣ患者抗－ＨＧＶ阳性率明显高于健康人群，显示ＨＧＶ感染与ＨＣＣ发生有关；同时在抗－ＨＧＶ阳性ＨＣＣ患者中ＨＢＶ感染率高达８２．６１％，提示ＨＧＶ和ＨＢＶ重叠感染可增加ＨＣＣ的发生.     

河北省供血员农村居民血清谷丙转氨酶异常的流行因素分析

对供血员较多的三个村２５０５位居民血清ＡＬＴ异常与各型肝炎病毒感染标志的关系进行了一半动态观察。首次检测ＡＬＴ异常率为３．２７％（８２／２５０５），抗－ＨＣＶ阳性和饮酒是ＡＬＴ异常的主要危险因素且二者有联合作用。一年后ＡＬＴ异常率为３．２２％（６７／２０７９）；原ＡＬＴ异常者２４．６４％（１７／６９）仍异常，与ＡＬＴ持续异常有关的主要因素是抗－ＨＣＶ，阳性者持续率为４４．４４％（４／９），阴性者持续率为１１．６３％（５／４３）；原ＡＬＴ正常者中有５０人（２．４９％）发生异常，抗－ＨＣＶ阳性和饮酒是发生ＡＬＴ异常的危险因素。甲型和乙型肝炎病毒感染对ＡＬＴ异常率及正常者一年后异常发生率的影响就总体人群而言均无统计学意义，但对儿童可能起主要作用。     

输血及血制品者丙型肝炎病毒感染调查

对深圳九龙海关职员有输血或血制品史者６６铭及对照组１４７名调查其ＨＣＶ感染情况。结果：输血组抗ＨＣＶ组性率为９．１％，明显高于抽样组的０．７％。输血组中以血浆者抗－ＨＣＶ检出最高，传播风险较大。丙种球蛋白及补血康输入者抗－ＨＣＶ阴性。抗－ＨＣＶ检出阳性者中ＡＬＴ升高者ＨＣＶＲＮＡ均阳性，提示ＨＣＶＲＮＡ水平与活动性肝损害相关。     

散发性戊型肝炎和散发性甲型肝炎的临床比较

本文对８０例散发性戊肝和１３１例散发性甲肝的临床资料进行比较，在急性期，戊肝患者血汪有的抗－ＨＥＶＩｇＭ阳性率为７３．８％，抗－ＨＥＶＩｇＧ阳性率为６３．８％，甲肝患者的抗－ＨＡＶＩｇＭ阳性率为１００％，抗－ＨＡＶＩｇＧ阳性率为９５．４％，与甲肝相比，戊肝的血清总胆红素水平较高（Ｐ〈０．０５）。黄疸持续时间变长（Ｐ〈０．０５），ＡＬＴ／ＡＳＴ比值降低（Ｐ〈０．００５），住院期长（Ｐ〈０．０５）。病     

丙型肝炎病毒RNA非结构区套式聚合酶链反应

目的探讨不同引物对ＨＣＶＲＮＡ检出率的影响，立敏感的ＮＳ５区基因扩增技术。方法选择不同引物，采用非结构５（ＮＳ５）区套式聚合酶链反应（ＰＣＲ）及联合式［ＨＣ非编码区（５′ＮＣＲ）与ＮＳ５联合］ＰＣＲ技术检测１０例抗ＨＣＶ阳性献血员及３７例输血后丙型肝患者的血清ＨＣＶＲＮＡ。结果１０例抗ＨＣＶ阳性献血员应用联合式ＰＣＲ，以ＮＳ５－３＋ＮＳ５－４、ＳＦ２＋ＮＳ５－４、Ｋ１＋ＮＳ５－４、ＮＳ５－１＋ＮＳ５－４引物及套式ＮＳ５－１＋ＮＳ５－４引物扩增时，其ＲＮＡ检出率分别为５／１０、６／１０、７／１０、８／１０和９／１０；而３７例输血后丙型肝炎患者中３５例ＲＮＡ阳性，检出率为９５％，其中１８例１ｂ型和１９例２ａ型样品的检出率分别为１００％和８９％。结论ＨＣＶＮＳ５区的ＲＮＡ检出率与引物的选择有关     

肝病患者和供血员血清中抗-HGV的检测及其意义

目的探讨肝病患者和供血员血清中抗 ＨＧＶ检测的意义。方法采用北京医科大学肝病研究所生产的试剂盒，对２２６例肝病患者和１８７例献血员血清中抗 ＨＧＶ进行检测。结果急性肝炎、慢性活动性肝炎、慢性迁延性肝炎、肝硬化、重型肝炎病人抗 ＨＧＶ阳性检出率分别为６．９％（３／４３），１７．９％（１９／１０６），１４．２％（５／３５），３３．３％（３／９）和９．１％（３．３３）。肝硬化患者血清中抗 ＨＧＶ的检出阳性率明显高于其它各型肝炎（Ｐ＜０．０５）。１８７例献血人员中检出抗 ＨＧＶ４例（２．１％）。结论作者认为在供血人员中对ＨＧＶ进行筛选，以避免和减少输血后肝炎的发生。     

丙型肝炎病毒感染与乙型肝炎

本文报告８５例ＨＣＶ感染者，并与同期经随机抽样而得的８５例抗一ＨＣＶ阴性的乙汗患者相比较。抗一ＨＣＶ阳性组输血史及输血制品史分别为３５．３％与１６．５％，而抗－ＨＣＶ阴生组分别为７．１％与０，两纽相比Ｐ＜０．０１，抗－ＨＣＶ阳性组注射史高于抗一ＨＣＶ阴性组（Ｐ＜０．０５），提示丙肝病毒医源性感染较ＨＢＶ多见，丙型肝炎有高龄发病趋向且其病程较乙于为长。ＨＣＶ感染者８２．４％存在ＨＢＶ重叠感染，ＨＣＶ７可抑制ＨＢＶ复制，ＨＣＶ与ＨＢＶ重叠感染预后较乙肝差。     

血透患者检测抗HCV IgM的临床意义

为探讨丙型肝炎ＩｇＭ抗体测定在血液透析患者中的临床意义,采秀间接ＥＬＩＳＡ法检测抗ＨＣＶ ＩｇＭ。同时采用ＥＬＩＳＡ测抗ＨＣＶ ＩｇＧ,ＲＴ－ＰＣＲ法测ＨＣＶ ＲＮＡ,并进行比较。结果示６２例血液透析病人中,抗ＨＣＶ ＩｇＭ阳性２７例（４３．６％）,抗ＨＣＶ ＩｇＧ阳性２９例（４６．８％）,ＨＣＶ ＲＮＡ阳性３４例（５４．８％）,任一项阳性３７例（５９．７％）;抗ＨＣＶ ＩｇＭ与ＨＣＶ ＲＮＡ检测     

HGV/GB virus C transmission by blood components in patients undergoing open-heart surgery

BACKGROUND: To establish the rate of HGV/GB virus C (GBV-C) transmission by blood components in open-heart surgery patients. STUDY DESIGN AND METHODS: From 55 patients receiving blood components, sera were collected before and 2, 4, 6, 8, 10, 12, 16, 20, 26, and 32 weeks after heart surgery. Serum samples from patients and implicated blood donations were tested for HGV/GBV-C RNA by PCR. Recipients of RNA-positive blood components were also tested for the presence of E2 antibodies (E2Ab) by ELISA. RESULTS: Of 55 recipients, 18 received RNA-positive blood components. Of 14 recipients of RNA-positive blood components, who were negative for RNA or E2Ab before transfusion, 8 became RNA positive and one developed E2Ab after transfusion. Three recipients of RNA-positive blood components had E2Ab before transfusion, and none of these became RNA positive after transfusion. One of 18 recipients was RNA positive before and after transfusion. Of 55 recipients, 37 received RNA-negative blood components: 34 were RNA negative before and after transfusion. Of 37 recipients, 3 were RNA positive before and after transfusion. CONCLUSION: Of susceptible patients, 64 percent became infected with HGV/GVC-C when transfused with RNA-positive blood components. E2Ab-positive patients were protected against HGV/GBV-C infection.     

血液病患者输血与庚型肝炎病毒感染的研究

目的：了解血液病患者输血后的庚型肝炎病毒（ＨＧＶ）感染情况。方法：对６３例血液病患者采用ＲＴＰＣＲ方法检测ＨＧＶＲＮＡ、丙型肝炎病毒（ＨＣＶ）ＲＮＡ，应用ＥＬＩＳＡ方法检测抗ＨＧＶ、ＨＢｓＡｇ。结果：ＨＧＶＲＮＡ阳性率为７．９％，抗ＨＧＶ阳性率６．３％；ＨＣＶＲＮＡ阳性率为４６．０％。ＨＧＶ感染通常伴有ＨＣＶ感染及丙氨酸转氨酶升高。ＨＧＶ感染与输血量有关，与血液病种类无关。结论：血液病输血可引起ＨＣＶ、ＨＧＶ的传播     

A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery

Allogeneic blood transfusion has been implicated as an independent risk factor for postoperative bacterial infection in clinical and animal studies. The association among transfusion, quantitative immunologic factors, and infection was examined in 102 patients undergoing 109 spinal fusion procedures. In 60 procedures, patients received autologous blood only; in 24 procedures, they received at least 1 unit of allogeneic blood, and in 25 procedures, they received no transfusions. Twenty-two patients developed bacterial infections, in 8 cases while in hospital and in 14 cases after discharge. Univariate analysis revealed that patients who received any allogeneic blood and those who received no allogeneic blood differed significantly in the rate of hospital-acquired infection (20.8 vs. 3.5%), length of stay (12.3 vs. 9.7 days), days of fever greater than or equal to 38 degrees C (4.0 vs. 2.9), days on antibiotics (3.9 vs. 2.5), duration of surgery (309 vs. 231 min), blood loss (1343 vs. 887 mL), surgeon, and postoperative drop in natural killer (NK) cells (-174 vs. -42/microL). Multivariate logistic and linear regressions revealed that the number of allogeneic units transfused was the only significant predictor of in-hospital infection (p = 0.016) or days on antibiotics and length of stay. None of the clinical, surgical, or transfusion variables was significantly associated with posthospital infection, although a significantly greater drop in NK cells had occurred in patients who developed infection (p = 0.0035). These data strongly implicate allogeneic transfusion as a risk factor for in-hospital postoperative bacterial infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Incidence and clinical presentation of posttransfusion TT virus infection in prospectively followed transfusion recipients: emphasis on its relevance to hepatitis

BACKGROUND: A novel transfusion-transmissible human DNA virus, TT virus (TTV), has been discovered recently. An attempt was made to determine the incidence and clinical outcome of TTV infection in recipients of blood transfusion. STUDY DESIGN AND METHODS: Serial serum samples collected as part of a prospective study of posttransfusion hepatitis were examined for TTV DNA by a nested PCR assay. RESULTS: Among 150 adults undergoing cardiac surgery, posttransfusion specimens from 59 individuals were positive for TTV DNA. Pretransfusion sera were found to be positive in 13 of these individuals. Therefore, 46 (33.6%) of the 137 previously uninfected patients developed new TTV viremia after transfusion. Among the 46 patients, 3 were coinfected with HCV, 5 were coinfected with HGV, and 38 were infected with TTV alone. No apparent symptoms or signs were noted in the 38 patients infected by TTV alone or the 5 infected with HGV plus TTV. The average peak serum ALT activity was 31 IU per L, with persistently normal levels in 34 of the 38 patients with TTV infection alone. In 8 other patients who subsequently developed well-documented non-A-G hepatitis, 3 were positive for TTV (3/8 vs. 46/137, p = 0.8). In 12 patients followed for more than 1 year, TTV viremia persisted in every case. CONCLUSION: In this population, TTV is transmitted by transfusion to approximately 30 percent of patients who undergo cardiac surgery. Most of the infections appear to become persistent. Despite the high prevalence rate, TTV does not appear to cause hepatitis on its own.     

Prevalence of hepatitis G in patients on chronic hemodialysis

Hepatitis G virus (HGV) is a newly described RNA virus from the family of flaviviridae. It is closely related to the hepatitis C Virus (HCV) but is more common than HCV among healthy blood donors. The pathogenicity of HGV in immunosuppressed patients such as those undergoing hemodialysis is unclear. We measured the incidence of HGV in 105 patients undergoing hemodialysis in a chronic outpatient hemodialysis facility. HGV-RNA was detected using a RT-PCR method with primers directed against the 5' non-coding region and the NS5a gene of HGV. Nine (8.6%) patients were HGV RNA positive, eleven (10.5%) were anti-HCV positive, three (2.9%) were positive for hepatitis B surface antigen. Four patients were positive for both HGV and HCV; three of them had normal liver enzymes while one showed elevated ALT levels but no other signs of exacerbation of preexisting hepatitis. The prevalence of HGV among dialysis patients is comparable to that of HCV. The transmission route for HCV is nosocomial transmission during dialysis, whereas HGV shows both ways of transmission: blood transfusion mediated by a high prevalence of HGV among healthy blood donors and nosocomial transmission. HGV appears to play a minor role in acute hepatitis, even in immunosuppressed patients.     

患者输血前感染性指标的检测及意义

目的：评估受血者在输血前接受输血相关传染病检查的意义。方法：对2305例受血者在输血前进行谷丙转氨酶（ALT）、乙型肝炎病毒表面抗原（HBsAg）、丙型肝炎病毒抗体（抗HCV）、艾滋病毒抗体（抗HIV）和梅毒试验（TPPA）检测。结果：HBsAg阳性、抗HCV阳性和两者均阳性的百分率分别为11．58％、1．69％和0．50％，其中92例HBsAg阳性者没有输血史，在输血前检查中首次捡出阳性；61例抗HCV阳性者均有输血史，在肾透析患者中，抗HCV阳性率达10．00％。ALT〉40U／L者567例，除并发HBsAg和（或）抗HCV阳性外，单独ALT升高者207例。抗HIV阳性者1例，TPPA阳性者1例。结论：对患者在输血前进行输血相关5项传染指标检测有重要的临床意义     

Investigation of transfusion transmitted viruses in cases clinically suspected of posttransfusion hepatitis with undetermined ethiology.

Transfusion transmitted viruses (TTV) were investigated in cardiac surgery cases who were previously transfused with blood and/or blood products and were suspected of having posttransfusion hepatitis (PTH) based on the results of physical examination, clinical findings, biochemical blood test results and in a smaller number, on radiological results. They were identified as having non-A-C hepatitis based on serological or molecular test methods. In this study, out of 90 cases suspected for PTH and non-A-C, 78 (86.7%) were male, 12 (13.3%) were female and their ages were between 17 and 67. Ninety healthy blood donors, who donated blood for the first time and had never had a transfusion, were selected as the control group. They had alanine aminotransferase (ALT) levels < 40 U, were seronegative for hepatitis B virus (HBV) and hepatitis C virus (HCV). Seventy-seven were immune, and 13 were seronegative for hepatitis A virus (HAV). In this study, TTV-deoxyribonucleic acid (DNA) investigation was performed by the polymerase chain reaction (PCR) method suggested by Takahashi et al. with 5' GCT ACG TCA CTA ACC ACG TG 3' (T801) and 5' CTG CGG TGT GTA AAC TCA CC 3' (T935) primers. TTV-DNA was found to be positive in 21 (23.3%) of the patient group and 4 (4.4%) of the control group (p < 0.05). In the patients determined to be TTV-DNA positive, the admission time following transfusion was a minimum of 3, and a maximum of 15 (average 7) weeks. The average ALT levels detected at the time of admission did not show a difference between TTV-DNA positive and negative cases (p > 0.05). However the ALT levels had a tendency to rise and reached their highest level nine weeks after transfusion in the TTV-DNA positive cases, although in two cases the ALT levels decreased to normal value after the 13th week. During the 24 month follow up of the TTV-DNA positives all cases except one were positive at the end of this period. The results of this study are the same as those reported in the literature suggesting that TTV-DNA, excluding the main viral agents which are known to cause PTH, can be determined in transfused PTH or non-transfused asymptomatic patients in varying ratios. In order to define the epidemiological properties and hepatic-extrahepatic pathologies more clearly we have looked for evidence of the viral agent, which probably contaminates both by transfusion and non-transfusion routes. It is suggested that, in addition to the case groups in this study, new clinical studies are necessary including transfused but non-PTH patients.