血液透析患者丙型肝炎病毒感染的研究

HEPATITIS C VIRUS INFECTION AMONG LONG TERM HEMODIALYSIS PATIENTS

为调查血液透析患者丙型肝炎病毒（ＨＣＶ）感染情况，并探讨相对危险因素，对１９９４年１２月～１９９５年６月在北京协和医院血透中心进行血液透析的８０例患者及１９９５年新入学的３０例研究生（健康对照）进行研究。采用第二代ＥＬＩＳＡ检测人类免疫缺陷病毒（ＨＩＶ）和ＨＣＶ抗体，逆转录巢式双聚合酶链反应（ＰＣＲ）法检测ＨＣＶＲＮＡ。追查８０例血液透析患者，２４例ＨＣＶ抗体阳性，５６例ＨＣＶ抗体阴性患者中，２例ＨＣＶＲＮＡ阳性，即８０例血液透析患者ＨＣＶ感染率３２．５％（２６／８０）。Ｍａｎｔｅｌ－Ｈａｅｎｓｚｅｌ法分析显示，血透患者ＨＣＶ感染与输血、透析时间、肾移植及手术史有关。９例ＨＣＶＲＮＡ阳性病人的透析液中，３例检出ＨＣＶＲＮＡ。表明血液透析患者ＨＣＶ感染率明显高于普通人群，主要危险因素是输血和免疫功能低下，透析设备和环境污染是不容忽视的危险因素。

We determined the prevalence and incidence of hepatitis C virus (HCV) infection among hemodialysis patients and evaluate their risk factors. 80 patients on maintenance hemodialysis in Peking Union Medical College Hospital Dialysis Center from December 1994 to June 1995 were studied. 30 medical students were used as health controls. Serum samples were tested for HCV antibodies by a second generation enzyme linked immunosorbent assay (ELISA) and for HCV RNA using nested polymerase chain reaction (PCR) and retested for anti HCV and HCV RNA three months later. 24 (30%) of 80 hemodialysis patients were anti HCV positive, and 2 (3.6%) of 56 anti HCV negative cases were found HCV RNA positive. By combined assessment, the HCV infection rate of hemodialysis patient was 32.5%(26/80). Mantel Haenszel analysis showed that HCV infection was associated with multi transfusions, dialysis over a long period, renal transplantation, history of operation. Samples of dialysate in 9 serum HCV RNA positive cases were directly detected for HCV RNA, and 3 were found HCV RNA detectable. HCV infection rate in hemodialysis patients is higher than that of general population. The main risk factors for HCV transmission is transfusion of unscreened blood but is not an independent factor, hemodialysis itself plays an important role, the length of time on dialysis, renal transplantation, blood contaminated material and contaminated dialysis equipment are also the risk factors. Infected hemodialysis patients should be isolated.