上海地区输血后丙型肝炎病毒感染者临床流行病学分析

The clinical epidemiologic characteristics of patients infected with hepatitis C virus post blood transfusion in Shanghai area

目的分析上海地区输血后HCV感染者的临床流行病学特点。方法采用PCR检测HCVRNA载量、ELISA检测抗-HCV，分析输血后HCV感染者的年龄、原发病因、暴露年份、输血成分与输血量、潜伏期和肝功能损害等。计数资料采用X^2检验，计量资料采用t检验和相关分析。结果327例中的279例（85．3％）感染者HCVRNA载量≥3．0log10拷贝／mL、中位数为5．99log10拷贝／mL；19．7％病例为3．0～4．0log10拷贝／mL，69．9％为5．0～6．0log10拷贝／mL。HCVRNA定性阳性率为81．6％（40／49），抗-HCV阳性率达99．7％（383／384），其阳性敏感度高于HCVRNA定量和定性检测（F=57．138，P=0．000；F=63．149，P=0．000）。输血后HCV＋感染以30～60岁年龄段多见，84．4％病例暴露时间为1990年至1994年间，感染者中10％以上总病例数的疾病分别为妇产科、骨科疾病和胃肠道出血。输入全血者占80．0％，输血至临床诊断时间平均为（86．0±54．6）个月。89．0％感染者有肝功能损伤，但大多数ALT升高水平≤5×正常值上限（ULN）。结论输血后HCV感染以成年人居多，常伴有肝功能损伤，但ALT升高≤5×ULN；血清HCVRNA载量多为中等水平。

Objective To investigate the clinical epidemiologic characteristics of patients with hepatitis C virus （HCV） infection post blood transfusion. Methods The polymerase chain reaction （PCR） and enzyme linked immunosorbent assay （ELISA） were used to detect HCV RNA and anti- HCV, respectively. Analysis was performed for patients＇ age distribution, cause of primary diseases, exposure years, ingredient and amount of transfusion, incubation period and liver function damage. The statistical processing were performed with chi-square test, t-test and correlation analysis. Results HCV RNA levels were higher than 3.0 log10 copy/mL in 85.3% infected patients with a median of 5.99 log10 copy/mL, among Which 19.7% patients showed viral load 3.0 to 4.0 log10 copy/mL and 69.9% showed 5.0 to 6.0 log10 copy/mL. Eighty-one point six percent （40/49） of infected persons were confirmed as HCV RNA positive by HCV RNA qualitative analysis, while 99. 7% （383/384） patients were detected as anti-HCV positive by serological test. The sensitivity of serological test was higher than both HCV RNA quantitative and qualitative assays （F=57. 138, P=0.000; F=63. 149, P= 0. 000, respectively）. HCV infection post blood transfusion was more common in people of 30 to 60 years old. Most cases （84.4%） got the first time exposure during 1990 to 1994. More than 10% cases had primary disease as obstetrics, orthopedics or gastrointestinal tract hemorrhage. Eighty percent received whole blood product transfusion. The mean interval between transfusion and clinical diagnosis was （86.0 ± 54.6） months. Eighty-nine percent of infected patients had liver function damage, while most of them showed elevated alanine aminotransferase （ALT） with no more than 5 upper limits of normal （ULN）. Conclusions Post transfusion HCV infection mainly happened in adulthood. Infected patients usually have liver＇function damage with elevated ALT with no more than 5 ULN and medium HCV RNA levels.