血液透析患者病毒性肝炎感染的情况调查

目的 调查血液透析患乙型、丙型和庚型肝炎病毒感染有其多重感染的情况，探讨其感染的危险因素。方法 对1478例血透患的血清进行HBsAg、HBsAb、HBeAb、HBcAb、HBV－DNA、anti－HCV、anti－HGV的检测。并随机抽取100例anti－HGV和anti－HGV阳性轿清RT－PCR方法检测HCV－RNA和HGV－RNA。结果 1478例轿清中HBV感染率为43．9％，HBV－DNA感染率为7．9％；HCV感染率42．6％；HGV感染率为46．4％。随机抽取100例anti-HCV和anti－HGV阳性血清；HCV－RNA和HGVRRNA的感染率分别为73％和77％。HBV合并HCV天津25．4％，HCV合并HGV感染21．0％，HCV、HBV、HGV3合并感染10．4％。结论 血透透析患存在着经血行感染乙型、丙型和庚型肝炎病毒的高危因素。     

乙型肝炎病毒和丙型肝炎病毒在合并感染者中的相互作用

目的 了解HBV和HCV在合并感染的慢性肝病患者中相互作用的特点.方法 收集2006年1月～2007年10月在我院治疗的慢性肝病(包括HBV和HCV合并感染引起的慢性肝炎或肝硬化、肝炎后肝硬化、慢性乙型肝炎、慢性丙型肝炎)患者的肝穿病理样本及其血清.所有病例均常规检测肝功能,血清HBV DNA、血清HBV标志物、血清HCV RNA、抗-HCV;所有肝活检样本均用10%中性福尔马林固定,石蜡包埋,作苏木精-伊红、Masson和网状纤维染色,并进行肝炎分级分期,HBsAg和HBcAg免疫组化,HBV DNA和HCV RNA原位杂交检测.结果 HBV和HCV合并感染的患者重型慢性肝炎(G4)发生率比HBV或HCV单独感染的患者高,分别为62.50%、27.05%和30.56%(P＜0.01).在HBV和HCV合并感染引起的慢性肝炎患者中,HBV DNA阳性率为4/32(12.5%),HCV RNA阳性率为24/32(75%),而HBV或HCV单独感染组分别为HBV DNA阳性107/122(87.7%)和HCV RNA阳性58/72(80.56%).结论 HBV和HCV合并感染可增加重型慢性肝炎的发生率.在HBV和HCV合并感染的患者中,HBV和HCV呈相互抑制的作用,主要表现为HCV对HBV的抑制.     

血液透析时间、次数与肝炎病毒感染结果分析

目的了解血液透析患者在血液透析时间、次数,发生感染病毒性肝炎（HBV、抗HCV、抗-HGV）及合并感染状况。方法223例血液透析患者,其中男137例．女86例,年龄在27－80岁之间进行HBV、抗-HCV、抗－HGV检测。结果乙、丙、庚型肝炎病毒的感染率分别为78．0％,35．0％和4．9％。血液透析忠者透析在6个月以内HBV感染率是448％;6个月以后都高于71．8％：抗－HCV感染率是10．3～69．2;抗FIGV感染率是0～10．3％。结论虹液透析足引发经血传播疾病的最危险因素之一。时间和次数是有密切的相关性。随时间和次数延长,其感染HBV、抗－HCV、抗－HGV阳性率也随之高。     

尿毒症血液透析患者医源性交叉感染状况调查

目的调查某医院血液净化中心维持性血液透析患者HBV、HCV、HIV、TP交叉感染情况,为临床防控提供科学依据。方法采用前瞻性设计,对近8年内133例血液透析患者进行不同层次分组透析,使用两种方法连续检测比对,数据采用t检验和χ2检验处理分析。结果 (1)133例维持性血液透析患者感染HBV 17例(12.78%)、HCV 22例(16.54%)、HBV和HCV混合感染2例(1.50%)、TP 2例,无HIV感染者。(2)HBV和HCV感染主要集中在移植性肾病、慢性肾炎、糖尿病肾病等患者中,二者感染率与在感染区透析关系密切,其中HCV感染率与移植性肾病相关、与输血史相关(P0.05);而HBV感染与输血史未见明显关联(P0.05),但透析后明显高于透析前(P0.05)。(3)连续对应检测近3年127例透析患者,仅有1例HBs Ag指标转为阳性,未发生HCV、HIV、TP新的交叉感染。结论 HCV感染与移植性肾病、输血史、移植次数高度有关,HBV感染存在透析后交叉感染的风险。血液净化中心严格按照《血液净化标准操作规程》认真操作,维持性血液透析患者的医源性交叉感染将明显减少。     

维持性血液透析患者丙型肝炎病毒感染调查分析

目的 观察维持性血液透析患者丙型肝炎病毒(HCV)的感染情况,并探讨其相关的危险因素,降低丙型肝炎感染率.方法 选择医院2010年1月-2011年12月行维持性血液透析的患者100例,采用ELISA法检测抗HCV、巢式PCR检测HCV-RNA,分析HCV感染与输血、透析时间、透析次数及透析医院数的关系.结果 100例患者中HCV感染4例,感染率为4.0％,且感染率随着输血次数、透析次数、透析医院数的增加及透析时间的延长,HCV感染率相应增高(P＜0.05).结论 维持性血液透析患者容易感染HCV,反复输血、透析次数多、透析时间长以及接受多所医院透析是其感染的危险因素.     

维持性血液透析及肾移植患者乙型及丙型肝炎病毒感染调查

目的 了解维持性血液透析及肾移植患者乙型及丙型肝炎病毒感染状况。方法 采用ELISA及PCR法测定HBVm、抗—HCV、HCVRNA，型特异性HCV亚基因探针杂交分型。结果长期血透者HCV阳性率为37．24％，肾移植术后再透析者达47．57％，且与透析时间、输血次数、受血量正相关；HCV基因型以混合型为主，占63．64％。结论 本组患者HBV、HCV感染率与输血次数、输血量及透析时间密切相关。     

维持性血液透析患者庚型肝炎病毒感染的研究

目的 了解血液透析患者庚型肝炎病毒(HGV)感染情况，探讨其危险因素。方法 采用酶联免疫法(ELISA)和逆转录—套式PCR法分别检测44例血透患者的抗—HGV抗体和HGVRNA。结果 血透患者HGV感染率为13．6％，HGV阳性组与阴性组相比输血次数较多、透析时间较长，但差异无显著性；而单独HGV阳性组与全阴性组相比透析时间明显延长，HGV感染与年龄、HBV感染、HCV感染及肝功能损害无显著相关。结论 血透患者HGV感染率明显高于普通人群，严格消毒措施、预防交叉感染、减少输血、血源中HGV筛查，对减少透析中庚型肝炎病毒感染至关重要。     

2003年大连市部分血液透析者肝炎及相关病毒感染现况调查

[目的]了解血液透析患者肝炎及相关病毒感染状况，为采取防治对策提供依据。[方法]2003年，对在大连市部分医疗单位血液透析中心治疗的223例血液透析者进行HBsAg、抗-HBs、抗-HBc、HBeAg、抗-HBe、抗-HCV、抗-HGV、抗-TTV检测。[结果]检测223人，HBsAg、抗-HBs、抗-HBc、HBeAg、抗-HBe阳性率分别为10．8％、40，8％、71，3％、6．3％、24．2％，HBV感染率为78．0％；抗-HCV、抗-HGV、抗-TTV阳性率分别为35．0％、4．9％、33．6％。223人中，感染1种病毒的113人，占50．67％；感染2种或2种以上病毒的84人，占37．67％。[结论]血液透析是HBV、HCV、HGV、TTV感染的重要途径。     

嘉兴市区人群肝炎病毒感染现状调查

按多阶段整群随机抽样方法,在嘉兴市区抽取三个居民会498人,进行五型肝炎病毒血清标志物检测.HAV感染率为64.06%;HBsAg、抗-HBs、抗-HBc阳性率分别为7.83%,24.30%和35.14%,HBV感染率为48.80%.HAV、HBV感染率均呈随年龄上升而增高的趋势.HCV感染率为2.61%,HEV感染率为8.03%.未发现HDV感染者.调查发现,各型之间的重叠感染类型有12种.     

河南信阳农村献血人员HIV、HCV、HBV感染情况分析

目的了解信阳市献血浆人群HIV、HCV、HBV感染率及其流行因素。方法对信阳市某县9个乡有偿献血浆人群聚集地村民进行HIV、HCV、HBV感染的流行病学调查。结果调查村民987人,发现HIV、HCV、HBV感染率分别为5．57％、26．14％、13．07％。其中有偿献血员604人,HIV、HCV感染率分别为8．94％、40．89％,显著高于非献血员的HIV、HCV感染率。结论豫南局部地区有偿献血浆人群中HIV、HCV感染率较高,在HIV阳性有偿献血浆人群中,HCV感染率很高,而HBV感染率则无此种现象。     

Gbv-C RNA presence in several high-risk groups of Spain

GB virus C subtype (GBV-C) seems to share the same routes of transmission as other parenteral transmitted viruses. We have evaluated the prevalence of GBV-C in 247 patients with potential risk for GBV-C infection and in 91 healthy blood donors. The presence of GBV-C RNA was examined by polymerase chain reaction in serum samples. The 23.6% of parenteral drug users were GBV-C positive, 36.3% of them were also HIV infected. Moreover, 22.5 and 19% of sera from patients with HBV and HCV chronic hepatitis, respectively, but without apparent risk factors seemed GBV-C infected. Finally, the 6% of patients on hemodialysis were also positive. Therefore, these results suggest that GBV-C is transmitted by parenteral routes but other non-parenteral routes shared with HBV or HCV must be considered.     

血液透析及丙肝病毒感染者F蛋白抗体分析

目的探讨丙型肝炎病毒(hepatitis C virus,HCV)F蛋白抗体在血液透析人群HCV感染者中的分布特点及其影响因素。方法利用pEGX-4T-2/HCV-F融合载体表达蛋白HCV-F/GST作为抗原,包被酶联反应板,间接ELISA法检测128例血液透析HCV感染者血清中的HCV-F抗体;Logistic回归分析患者特征与HCV-F抗体是否阳性的关系。结果 128例HCV感染者中F抗体阳性率为45.3%;单因素分析显示,血透时间、HBcAb、HCV RNA与F抗体是否阳性的差异有统计学意义(分别P=0.038、P=0.012和P=0.002);多因素分析显示,血透时间>10年(OR=4.153,95%CI=1.435～12.023)、HCV RNA阳性(OR=3.6979,5%CI=1.498～9.123)是HCV-F抗体阳性的影响因素。结论血液透析人群HCV感染者中可检出F抗体;F蛋白的表达可能与HCV复制有关。     

The prevalence of TT virus and GB virus C/hepatitis G virus infection in individuals with raised liver enzymes but without HBV or HCV infection in Taiwan

The prevalence of TT virus (TTV) and GB virus-C/hepatitis G virus (GBV-C/HGV) infection and the association with raised liver function tests in 546 Taiwanese with negative HBsAg, anti-HCV and HCV RNA was elucidated. They were tested for serum alanine aminotransferase (ALT), GBV-C/HGV RNA, anti-envelope protein 2 antibody (anti-E2) and TTV DNA. Direct sequencing and phylogenetic analyses were performed on 58 isolates for TTV genotype determination. The prevalence of TTV DNA, GBV-C/HGV RNA, anti-E2 and over all GBV-C/HGV exposure was 24.9, 3.4, 8.2 and 11.1%, respectively. Using uni- and multi-variate analyses, male gender and TTV viremia were associated significantly with raised ALT values. Sixty-nine percent of TTV isolates were deduced to be TTV genotype 1 and they had significantly lower mean age than genotype non-1 isolates. In the population, raised ALT may be related to male gender and be attributable to TTV infection but not to GBV-C/HGV among individuals with no evidence of current HBV and HCV infection. TTV genotype 1 is the most prevalent genotype and associated with younger age.     

Viral co-infections in hepatitis C: HBV, HBV-C/HGV and TTV studies

BACKGROUND/AIMS: The prevalence of co-infections with hepatitis B virus (HBV) and novel hepatitis viruses GBV-C (Hepatitis G virus, HGV) and TT virus (TTV) in chronic hepatitis C (HCV) infection has been studied. In patients with chronic hepatitis C and in asymptomatic healthy HCV carriers, the influence of these agents on the course of HCV infection was assessed. METHODS: a total of 110 HCV-positive individuals, among them 77 patients with chronic hepatitis C--50 of them treated with interferon (IFN)--and 33 HCV carriers with normal alanine aminotransferase have been investigated. HBV-DNA, HGV RNA and TTV DNA were detected by PCR, to determine HBsAg and anti-HBc ELISA technic has been used. RESULTS: In the healthy population, the prevalence of anti-HCV was 0.3%, HBsAg 0.09%, anti-HBc 2.5%, HGV RNA 8.0% and TTV DNA 18.5%, respectively. In chronic hepatitis C HBsAg (accompanied with HBV-DNA) occurred in 1.29%, anti-HBc 25.97%, HGV RNA in 9.09% and TTV DNA in 40.25% of cases. In IFN-treated patients with sustained remission, the frequency of TTV was 20% vs. 45.7% found in non-responders. Among asymptomatic HCV-carriers, the prevalence of anti-HBc was 27.27%, HGV RNA 9.09% and TTV DNA 75.7% respectively. CONCLUSIONS: Neither previous HBV infection, nor HGV RNA and TTV DNA had apparent effect on the course of chronic HCV infection. TTV was detected with the lowest frequency in persons with sustained remission due to IFN, suggesting antiviral effect of IFN on TTV.     

乙型肝炎患者重叠感染丙型肝炎、庚型肝炎病毒的研究

[目的 ]了解乙型肝炎患者重叠感染丙型肝炎病毒 (HCV)、庚型肝炎病毒 (HGV)的情况。 [方法 ]应用 EL ISA法分别对 86 8例乙肝患者、5 17例乙肝病毒携带者检测血清抗 - HCV和抗 - HGV,应用逆转录聚合酶链反应法分别对HCV、HGV感染者进行血清 HCV- RNA、HGV- RNA检测 ,并与乙肝病毒携带者比较。 [结果 ]乙肝患者与乙肝病毒携带者 HCV感染率分别为 14.5 %、2 .3% ,HGV感染率分别为 15 .6 %、3.9% ,HCV和 HGV的重叠感染率分别为 2 .3%、0 .2 % ,两组间 HCV、HGV合并感染率均有非常显著性差异 (P<0 .0 1)。乙肝患者中 HCV感染者 HCV- RNA阳性率14.3% ,HGV感染者 HGV- RNA阳性率 11.9%。 [结论 ]乙型肝炎、丙型肝炎、庚型肝炎可以重叠感染。急慢性乙型肝炎患者的 HCV、HGV重叠感染率不同。     

Seroprevalence of hepatitis B virus, hepatitis C virus and GB virus-C infections in Siberia

We studied the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and GB virus-C (GBV-C) infections in 348 Siberian natives who lived in the Kamchatka Peninsula of Russia. Of 348 samples studied, the seroprevalence of HBsAg and anti-HBs were 11.8% (41 of 348 samples) and 35.9% (125 of 348 samples), respectively. The prevalence of HCV infection was 1.4% (5 of 348 samples), and that of GBV-C RNA, using RT-PCR methods, was 7.5% (26 of 348 samples). In Siberia, the prevalences of HBV and GBV-C infections were about tenfold higher than those in Japan. The prevalence of HBsAg in subjects under 50 years of age was significantly higher than that in those over 50 years old (P < 0.05). Because HBV infection is highly endemic in Siberia, we propose that the community-based mass immunization must be conducted as soon as possible in this area.     

An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom

ObjectivesThe prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing.MethodsA Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold.ResultsIn the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher.ConclusionsEmergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines.     

48例静脉药瘾者多重病毒感染临床分析

目的探讨静脉药瘾病毒性肝炎患者多重病毒感染率及转归。方法对48例静脉药瘾病毒性肝炎患者进行乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、人免疫缺陷病毒（HIV）血清标志物及核酸测定,并进行临床分析。结果48例静脉药瘾病毒性肝炎患者中,HBV、HCV双重感染率为31.25%,HBV、HIV双重感染率为4.17%,HBV、HCV、HIV三重感染率为62.50%;重型肝炎者占70.83%。重型肝炎患者住院时间为（48.67±19.25）d,与同期住院的非药瘾重型肝炎患者住院时间（65.32±31.49）d相比,明显缩短（U=4.25,P＜0.01）。结论静脉药瘾者病毒重叠感染率高,且重型肝炎患者多,但相对非药瘾重型肝炎患者恢复较快。