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.

The risk factors of hepatitis C virus infection in maintenance hemodialysis patients

Objective The aim of this study was to investigate the incidence of hepatitis C virus （HCV）infection and its risk factors in hemodialysis patients.Methods We retrospectively analyzed 183 patients treated in our hemodialysis center for more than 3 months.Results HCV infection was found in 19 patients （10.38％）,in whom HCV-RNA was positive in 19 patients,and anti-HCV antibody was positive in 13 patients （7.1％）.Univariate analysis indicated that HCV infection was related to dialysis vintage,times of hemodialysis,times of dialysis at different places,reuse of dialyzer,and history of hepatitis B infection （P＜0.05）.Multivariate logistic analysis indicated that hemodialysis at different places （OR=1.060,95％ CI=1.019～ 1.103,P=0.004） and hepatitis B infection （OR=3.816,95％ CI=-1.119～13.009,P=0.032） were the independent risk factors for HCV infection.Conclusion Maintenance hemodialysis patients are at high-risk for HCV infection.Strict and comprehensive isolation measures including establishment of specific dialyzers in isolated rooms for HCV positive patients,appropriate ratio of patient/medical staff,and prevention from sharing intravenous drugs,reusing dialyzer,and most importantly,reducing hemodialysis frequently at different places,cutting off the route of transmission of HBV infection can reduce Hcv infection rate in hemodialysis patients.