维持血液透析患者丙型肝炎病毒感染的研究

目的探讨长期维持性血液透析(HD)患者感染丙型肝炎与血液透析、输血的关系及临床指导意义.方法用ELISA和PCR法检测242例血液透析患者血清中抗HCV和HCV-RNA.结果血液透析患者丙型肝炎病毒感染明显高于对照组(P＜0.01),血液透析患者输血组明显高于非输血组(P＜0.01),血液透析患者输血组与非输血组,乙型肝炎病毒感染差异无显著性(P＞0.05).结论血液透析易感染丙型肝炎病毒,输血是引起血液透析患者丙型肝炎病毒感染的最主要原因.接受异体输血的次数和量越多,感染的机率越大,阳性检出率则越高.     

血液透析患者丙型肝炎病毒感染的预防

长期维持血液透析 (HD)患者 ,丙型肝炎病毒(HCV)易经输血和HD过程中的交叉感染传播。作者总结了肾内科血透室 1 990～ 1 992年及 1 997～ 1 999年间HCV感染采取预防措施前后对患者进行的 6次HCV感染调查结果 ,现报告如下。1　临床资料血清均取自本院肾内科血透室长期维持HD的住院或门诊透析患者 ,穿刺针头、注射器均为一次性使用 ,运血导管、透析器为多次复用 ,采用次氯酸钠、福尔马林清毒。调查共 6次 ,1 990～1 992年 3次为第 1阶段 ,此阶段输血量未限制 ,血透机、复洗导管、透析器等未做到HCV抗体阴性与阳性患者分开。 1 997年起…     

维持性血液透析患者丙型肝炎病毒感染的危险因素

目的 探讨深圳市第二人民医院血液透析中心维持性血液透析（maintenance hemodialysis,MHD）患者丙型肝炎病毒感染的发生率及相关危险因素. 方法 研究对象为2001年1月至2013年3月于本中心接受MHD达3个月或以上的患者共183名,收集患者的一般资料、临床资料、实验室数据进行分析. 结果 183例MHD患者中有19名患者感染HCV（10.38％）,其中抗HCV抗体13例（7.1％）,HCV-RNA阳性19例（10.38％）.单因素分析表明,HCV感染与透析龄、透析总次数、异地透析次数、复用透析器、乙型肝炎病毒感染相关（P.＜0.05）.多因素logistic回归分析提示,异地透析次数（0R=1.060,95％ CI=1.019～1.103,P=0.004）及乙型肝炎病毒感染（0R=-3.816,95％ CI=1.119～13.009,P=0.032）为本中心MHD患者HCV感染的独立危险因素.结论 MHD患者是丙型肝炎病毒感染的高危人群,通过采取严格隔离措施如血透室分室分机、血透室患者/医务人员合理的比例避免共用注射药物及复用透析器,减少频繁异地透析及控制乙肝病毒的传播可有效的控制HCV传播、降低HCV感染率.其中严格控制异地透析频度及乙肝患者传播途径对防治透析中心丙肝病毒感染具有重要临床意义.     

维持性血液透析患者丙型肝炎病毒感染的研究进展

血液透析(HD)患者并发肝脏疾患是影响其病死率的一个重要因素。丙型肝炎病毒(HCV)是透析患者肝病的一个主要原因。输血后的非甲非乙型肝炎中90%以上为HCV所致。本文拟对HD患者HCV感染的流行病学、实验室监测、临床特征、危险因素以及防治措施进行综述。1流行病学HCV为一种单链R     

维持性血液透析患者冠心病事件与丙型肝炎病毒感染的相关性

目的探讨丙型肝炎病毒(hepatitis C virus,HCV)感染与维持性血液透析患者(maintenance hemodialysis,MHD)冠心病(coronary artery disease,CAD)事件的相关性。方法横断面调查分析2011年7月广东省人民医院血液净化中心所有MHD患者的感染控制筛查结果,按HCV阳性和HCV阴性分组,比较两组间CAD的患病率并作多因素logistic回归分析。结果 377例MHD患者中,HCV阳性率为9.0%,CAD患病率为23.9%;HCV阳性组CAD患病率为41.2%,明显高于HCV阴性组(22.8%,P=0.013)。Logistic相关分析显示,MHD患者CAD的发生与HCV感染无关,而年龄、血红蛋白及低密度脂蛋白水平是MHD患者发生CAD的独立危险因素。结论 HCV感染并非MHD患者CAD事件的危险因素,HCV能否预测MHD患者的CAD事件需要前瞻性研究来证实。     

维持性血液透析患者乙、丙型肝炎病毒感染情况及原因分析

目的:调查维持性血液透析患者在长期血透治疗过程中乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)的感染情况并分析其原因,以达到进一步采取预防措施,防止血透患者感染HBV和HCV。方法:收集2003年5月在本院行维持性血液透析半年以上者共99例,调查其血透史及输血史,检查其血清HBV标志物(HBV鄄M)和HCV抗体(抗鄄HCV)情况,并与患者初始血透治疗前该指标比较,分析血透中HBV、HCV感染发生情况及原因。结果:①初始血透治疗前99例患者中抗鄄HBs阳性51例,HBV鄄M全阴性者48例;2003年5月51例抗鄄HBs阳性者仍保持不变,但48例HBV鄄M全阴性者中13例各HBV相关抗体出现,占27.1%,其余35例HBV鄄M仍为全阴性;13例出现HBV抗体的患者接受血透治疗平均为3.5年,9例有输血史,与35例仍为HBV鄄M全阴性者相比无显著差异。②初始血透治疗前99例患者中抗鄄HCV阳性2例,抗鄄HCV阴性者97例;2003年5月上述患者中新增抗鄄HCV阳性51例,新增感染者与未感染者相比,血透治疗的时间显著较长(P<0.01),有输血史的患者亦显著增加(P<0.05)。结论:与普通人群相比血透患者感染HBV的危险性相当大;血透患者中存在着较高的HCV感染率,可能与HCV有较大的变异性导致对传染源的诊断遗漏以及丙型肝炎传播途径的多样性有关。     

血液透析人群丙型肝炎病毒感染的多中心临床研究

目的探讨多中心维持性血液透析(maintenance hemodialysis,MHD)人群丙型肝炎病毒(hepatitis C virus,HCV)感染的发生率、危险因素以及血清转氨酶水平的变化。方法采集多中心MHD患者病史、输血史、肾移植史等临床资料,检测丙氨酸氨基转移酶(alanine transaminase,ALT)、天冬氨酸氨基转移酶(aspartate transaminase,AST)、抗HCV抗体及HCV-RNA。结果 796例透析患者抗HCV抗体阳性176例(22.1%),其中HCV-RNA阳性142例(80.7%)。单因素分析表明,MHD患者的HCV感染与透析时间、输血率、透析器复用率及肾移植有关(均P<0.05)。多因素logistic回归分析提示透析时间(OR=1.38,95%CI=1.24～1.53,P<0.05)和透析器复用史(OR=10.91,95%CI=5.52～21.55,P<0.05)是HCV感染的独立危险因素。HCV感染组和HCV未感染组的ALT水平分别为(25±30)U/L和(12±13)U/L,AST水平分别为(24±20)U/L和(16±14)U/L,差异均有统计学意义(均P<0.05)。HCV感染组和HCV未感染组的ALT异常增高率分别为17.0%(30/176)和2.4%(15/620),AST异常增高率分别为10.5%(18/171)和4.8%(29/608),差异均有统计学意义(均P<0.05)。结论抗HCV抗体阳性的透析患者可进一步检测HCV-RNA以判断其活动性;监测血清转氨酶水平虽不宜作为判断血液透析患者HCV感染的敏感指标,但可作为了解肝损害的指标;针对MHD患者应当采取综合措施,控制HCV的传播,降低感染率。     

维持性血液透析患者乙型和丙型肝炎病毒感染的情况分析

维持性血液透析(血透)是慢性肾衰尿毒症维持生命的基本治疗手段,在接受血液透析治疗的尿毒症患者中,乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)的感染远远高于一般人群,已成为血透的主要并发症之一,我们对维持性血透3个月以上的69例患者作一调查,旨在了解长期接受血透治疗患者HBV和HCV感染的相关因素,以便进行有效的预防,控制其发病率。1资料与方法1.1病例选择选择2002-2006年于我院行维持性血透治疗的尿毒症患者69例,男39例,女30例,年龄14-80岁,平均(46±17)岁。透析次数2-3次/周,透析时间3个月至14年。原发病:高血压肾病20例,糖尿病肾病1…     

血液透析患者丙型肝炎病毒感染的特点及防治

1 流行病学丙型肝炎病毒(hepatitis C virus,HCV)为一种单链RNA病毒,直径50～60nm,大约由9400个核苷酸组成.近似于人类黄热病病毒[1].HCV的传播途径主要是输血和血液制品,性接触,经胎盘垂直传播的机会很少.与乙肝病毒相比,HCV在血液中滴度较低,对一般的化学消毒剂敏感,加热100℃ 5min,其传染性消失,血清中的HCV在室温下传染性会显著减退.然而,在血液透析环境中血液污染的潜在危险较高,短期存活的HCV可能更易引起感染,如果日常用品公用就可能被污染.另外,感染了HCV后的感染持续状态成为一个巨大的传染源.     

丙型肝炎病毒感染对维持性血液透析患者炎症因子及糖代谢的影响

目的探讨丙型肝炎病毒(hepatitis C virus,HCV)感染对慢性肾衰竭维持性血液透析患者的微炎症状态及糖代谢的影响。方法单中心、有对照、横断面研究,比较21例HCV抗体阳性维持性血液透析患者(阳性组)与51例HCV抗体阴性患者(阴性组)的空腹血糖、空腹胰岛素和C肽水平及胰岛素抵抗指数(稳态模式评估法,homeostasis model assessment of insulin resistance index,HOMA-IR)等糖代谢指标以及C反应蛋白(C-reactive protein,CRP)和肿瘤坏死因子á(tumor necrosis factor-á,TNF-á)等炎症指标,所有患者均维持性血液透析6个月以上,透析开始前均无糖尿病史和器官移植史,6个月内无使用糖皮质激素和免疫抑制剂史,2周内无发热和感染史。两组患者年龄、性别比例及体质量指数差异均无统计学意义(P0.05)。结果阳性组平均透析治疗时间较阴性组长,分别为(53±21)月和(32±18)月。阳性组丙氨酸氨基转移酶较阴性组高,分别为(33±19)U/L和(14±14)U/L,差异有统计学意义(t=1.85,P=0.034)。两组患者的血浆白蛋白、空腹血糖和C肽水平差异均无统计学意义(P0.05),但阳性组空腹胰岛素水平高于阴性组,分别为(12.18±3.05)pmol/L和(10.52±2.98)pmol/L,差异有统计学意义(t=2.12,P=0.037);阳性组HOMA-IR也显著高于阴性组,分别为2.67±0.87和2.21±0.75,差异有统计学意义t=2.36,P=0.027);阳性组和阴性组CRP分别为(0.34±0.11)mg/dl和(0.12±0.04)mg/dl,差异有统计学意义(t=2.65,P=0.009);TNF-á分别为(22.09±7.16)pg/ml和(10.31±4.87)pg/ml,差异有统计学意义(t=2.07,P=0.045)。而且空腹胰岛素水平和HOMA-IR均与TNF-á、CRP水平呈显著的正相关。结论合并HCV感染会进一步加重慢性血液透析患者的炎症状态,并进一步导致胰岛素抵抗。     

Risk of hepatitis C infection in neonates transfused with blood from donors infected with hepatitis C

This look-back study was undertaken to identify newborn infants who had been infected with the hepatitis C virus (HCV) as a result of transfusions received before the introduction of routine screening in 1991 and to determine the transmission rates and persistence of transfusion-transmitted HCV infection acquired in the neonatal period. A total of 24 infants, transfused between 1980 and 1991, were identified as having received potentially infected blood from 11 blood donors. Ten of the donors had been administered batches of anti-D in 1977 known to have transmitted HCV genotype 1b infection. HCV RNA was detected in five of these donors when tested in 1994–95; the past donations of five of the donors, who had received anti-D immunoglobulin and had serological evidence of previous HCV infection but who were PCR negative when tested in 1994–95, were considered of lower risk. The source and time of acquisition of HCV infection for the one remaining donor in the study was not determined. Twenty-one (88%) of the 24 children were living at time of lookback. The median age at transfusion was 12 days. The median age at time of testing was 6.3 years. One child, who tested negative, was excluded from further analysis of HCV transmission, due to incomplete transfusion records. Overall, 12 of 20 (60%) children tested were positive for anti-HCV and seven (35%) were HCV RNA positive. Twelve (71%) of the 17 recipients of viraemic blood were ELISA positive and seven (41%) were PCR positive. Resolved HCV infection, as determined by ELISA pos, RIBA pos or indeterminate and PCR negativity, occurred in five of 12 (42%). In many instances there was more than one recipient per HCV infected donation. All of the reported children are clinically asymptomatic. However, the duration of HCV infection is relatively short and there is evidence of a degree of hepatitis in five of the seven children who are HCV RNA positive as judged by mildly elevated transaminase levels. The three who have undergone liver biopsy show mild hepatitis. The lower rates of persistence of HCV infection in this study may be due to the young age at exposure or to the source of infection which for all but one of the children was linked to one HCV genotype from female donors. Sharing of units of blood among multiple infants should be discouraged.     

Risk of hepatitis C in patients who received blood from donors subsequently shown to be carriers of hepatitis C virus

SUMMARY. A retrospective study was undertaken to identify recipients of blood from donors subsequently shown to be positive for hepatitis C virus using second-generation tests and polymerase chain reaction. The main aims were to determine the numbers of such recipients who were still alive and traceable, and to determine the risk of infection in this group. The feasibility and workload of this procedure, which is currently not practised in the U.K. or U.S.A., was also assessed.
In the first six months of routine testing 42,697 donors were tested. Of 20 confirmed to be HCV-positive, 15 were regular donors. Eighty-three components were prepared from 63 anti-HCV positive previous donations from these donors. In all, nine recipients were found to be alive. All were positive for anti-HCV. We conclude that although this retrospective procedure is time-consuming and difficult, substantial numbers of infected recipients can be identified. The availability of treatment for chronic hepatitis C for such patients should encourage transfusion services to reassess current policies on the hepatitis C retrospective.     

昆明地区丙肝患者合并HBV隐性感染实验室调查与研究

目的 分析昆明地区丙型肝炎(简称丙肝)合并乙型肝炎病毒(HBV)隐性感染状况和相关实验室特征.方法 酶联免疫吸附法对244例抗丙型肝炎病毒IgG类抗体[抗-HCV(IgG)]阳性血清标本进行HBV血清标志物(HBVM)检测,同时检测丙氨酸氨基转移酶(ALT)及胆红素(Bil)水平.选择HBsAg阴性标本,以巢式PCR技术和荧光PCR技术进行HBV DNA定性及定量检测.结果 244例抗-HCV(IgG)阳性标本中HBsAg阴性198例,其中HBV DNA阳性76例,丙肝患者合并HBV隐性感染率为31.15%(76/244),包含5种HBVM模式,分别为抗HBs(+)、抗HBe(+)、抗-HBc(+)4例(A组),抗HBe(+)、抗-HBc(+)40例(B组),抗HBs(+)、抗HBc(+)5例(C组),抗-HBc(+)24例(D组),HBVM全阴3例(E组),B组所占比最高(P<0.05),D组HBV DNA平均含量最高(P<0.05).90.8%(69/76)的标本ALT、Bil均增高.老年男性为丙肝伴HBV隐性感染高发人群.结论 该地区丙肝合并HBV隐性感染发病率较高,且HBVM种类多样.HBV DNA检测是判断丙肝患者HBV感染状况的重要方法.     

丙肝病毒感染对维持性血液透析患者预后的影响分析

目的探讨分析丙肝病毒感染对维持性血液透析患者预后的影响。方法2001年1月至2005年1月我院维持性血液透析864例,根据有无丙肝病毒感染分为丙肝病毒感染组217例,非丙肝病毒感染组647例,观察两组肝功能情况、生存率并进行比较。结果丙肝病毒感染率25．11％;丙肝病毒感染组、非丙肝病毒感染组患者的肝功能比较P〉0．01有显著差异性;丙肝病毒感染组、非丙肝病毒感染组患者的生存率1年生存率比较P〉0．05,无显著差异性。两组2～4年、5年生存率比较P〉0．01有显著差异性。结论丙肝病毒感染对维持性血液透析患者的远期生存率有着显著的影响,严重影响患者的生存质量和生命健康。影响维持性血液透析患者预后的危险因素有高龄、糖尿病、心血管并发症、透析不充分、营养不良等因素,应把丙肝病毒感染列入影响维持性血液透析因素之中。     

抗原抗体联合检测在提高血液透析患者丙肝感染检出率中的应用

目的探讨开展抗原抗体联合检测在提升血液透析治疗患者丙肝感染检出率中的应用价值。方法收集100例血液透析患者的临床资料,分别采用以下方法测定相关参数:ELISA法检测HCV核心抗原、化学发光法检测抗HCV抗体、RTPCR法检测HCV-RNA,统计各检测项目在同一标本中的阳性表达情况,比较单测抗原、抗体与联合检测3个检测方案对于RNA阳性标本的检出率;同时对抗原阳性标本的抗原水平与其RNA拷贝数进行相关性分析并比较抗体阳性标本中其RNA阳性与阴性组组间抗体水平的区别。结果单测抗原或抗体均会造成血透患者丙肝感染的漏检,对于RNA阳性标本的检测中抗原抗体联合检测的检出率最高(P0.05),抗原阳性标本的抗原水平与其对应标本的RNA拷贝数呈正相关关系(r=0.85,P0.05),而抗体阳性标本中其RNA阳性与阴性组的组间抗体水平的差异不具有统计学意义(P0.05)。结论 HCV抗原抗体联合检测能有效提高血液透析治疗患者丙肝感染的检出率,同时HCV核心抗原检测也可作为抗体阳性患者HCV再次感染的监测指标之一。     

Post-transfusion hepatitis C in Finland

Summary. Six of 11 (55%) non-A, non-B hepatitis (NANBH) patients seroconverted to hepatitis C virus antibody (anti-HCV) positivity 8–16 weeks after transfusions in a prospective post-transfusion hepatitis study on 685 open-heart surgery patients in Finland. Five of them had a seropositive donor, and two of the five non-converted NANBH patients had received an anti-HCV positive unit. Among 36 studied donors who were positive in the anti-HCV ELISA, reactivity of both the antigen bands in a recombinant immunoblot assay (RIBA) for anti-HCV was significantly associated with NANBH ( P < 0·00005) in the recipient. In addition, infective anti-HCV positive donors had raised ALT values more often than seropositive donors which caused no seroconversion or infection in the recipients ( P = 0·0001).