维持性血液透析患者的丙型病毒性肝炎感染率

目的　评价血液透析(血透)患者丙型肝炎病毒(HCV)感染状况、HCV阳转率及危险因素。方法　采用第2代酶链免疫吸附试验(ELISA2,和逆转录聚合酶链反应(RTPCR)检测62例血透患者血清抗HCV和HCVRNA,采用ELISA2随访1995年6月～1996年12月间199例血透患者HCV阳转情况。结果　62例患者中,抗HCVIgM阳性27例(43.6%),抗HCVIgG阳性29例(46.8%),HCVRNA阳性34例(54.8%),3项至少1项阳性37例(59.7%)。HCV阳性组与阴性组相比,两组在性别、年龄、肾功能、HBV标志、EPO应用、CAPD史无明显差异,而在平均透时间、输血史、ALT异常、肾移植史方面有显著性差异。1995年6月抗HCV阳性率为58.7%,每隔半年的阳性率分别为53.7%、54.8%和50.0%。在18个月随访期间,31例阳转;156例随访1～6月,阳转14例(8.9%),67例随访7～12月,15例(22.4%)阳转,6例随访13～18月,2例(33.3%)阳转;2例阳转并转为肝硬化。结论　血透患者中HCV感染严重,输血为血透患者感染HCV的主要途径,但也存在医源性传播的可能。

Hepatitis C Virus Infection Rate in Patients on Maintenance Hemodialysis

Purpose To asses the prevalence of hepatitis C virus (HCV) infection in hemodialysis (HD) patients, the incidence and risk factors for positive seroconversion (SC) of HCV. Methods Sixty two HD patients were evaluated by using second generation ELISA (ELISA 2) to detect serum HCV antibodies and RT?PCR to detect serum HCVRNA;199 HD patients were followed by using ELISA 2 from June 1995 through December 1996. Results Twenty seven patients (43.6%) were anti HCVIgM positive,29 patients ( 46.8 %) were anti HCVIgG positive,34 patients (54.8%) were HCVRNA positive,the total positivity of HCV marker being 59.7%(37/62).Comparing the HCV marker between positive and negative groups,no significant differences were found with respect to the sex,age,renal function,HBV marker,EPO and history of CAPD;but there were significant differences with regard to the duration of dialysis,history of transfusion,ALT abnormality and kidney transplantation.Prevalence rates of HCV antibody of 58.7%,53.7%,54.8% and 50.0% were found in four consecutive six month periods.During the 18 month follow up period,31 patients became ELTSA 2 positive.Among 156 patients followed up for 1-6 months,14(8.9%) had HCV converted to positive;among 67,followed up for 7-12 months,15(22.4%) were SC HCV positive;among 6,followed up for 13-18 months,2(33.3%) were positive.Of these 31 HCV positive converted patients, 2 became liver cirrhosis. Results Twenty seven patients (43.6%) were anti HCVIgM positive,29 patients ( 46.8 %) were anti HCVIgG positive,34 patients (54.8%) were HCVRNA positive,the total positivity of HCV marker being 59.7%(37/62).Comparing the HCV marker between positive and negative groups,no significant differences were found with respect to the sex,age,renal function,HBV marker,EPO and history of CAPD;but there were significant differences with regard to the duration of dialysis,history of transfusion,ALT abnormality and kidney transplantation.Prevalence rates of HCV antibody of 58.7%,53.7%,54.8% and 50.0% were found in four consecutive six month periods.During the 18 month follow up period,31 patients became ELTSA 2 positive.Among 156 patients followed up for 1-6 months,14(8.9%) had HCV converted to positive;among 67,followed up for 7-12 months,15(22.4%) were SC HCV positive;among 6,followed up for 13-18 months,2(33.3%) were positive.Of these 31 HCV positive converted patients, 2 became liver cirrhosis. Conclusions HCV infection in HD patients is serious and blood transfussion appears to be the primary risk factor,but nosocomial transmission in the dialytic enviroment may be present.