血液透析丙型肝炎病毒跨膜通透的临床研究

Passage of Hepatitis C Virus Across Dialysis Membrane:A Clinical Study

目的对透析膜施加特定条件，寻求丙型肝炎病毒（HCV）跨膜转运的临床依据。方法选择10例HCV-RNA标志物阳性的血液透析患者，研究分两个阶段，第1阶段应用低通量聚乙烯醇膜透析器，第2阶段应用高通量聚砜膜血滤器，均在250-400mmHg的高跨膜压（TMP）和无肝素的条件下，每例患者应用低通量与高通量单超透析各2次，共留取40份单超液，用RT-PCR检测单超液中的HCV-RNA标志物。结果第1阶段留取的20份单超液HCV～RNA标志物均阴性，第2阶段留取的20份单超液中有2份HCV-RNA标志物呈阳性，这2份阳性标本均出自同一患者。结论使用低通量透析器，即使再高TMP情形下，HCV不容易跨膜通过，但在使用高通量透析器，在高TMP的特定条件下有可能导致HCV从血液中逃逸至膜外。

OBJECTIVE To study the HCV infection path in order to find the clinical evidence of HCV passage across the dialysis membrane the extreme conditions of permeability are applied to which, METHODS With high flux dialyzers, 10 patients of HCV RNA-positive were underwent ultrafiltration dialysis without dialysis solution, twiceeach patient, under the extreme condition of trans membrame pressnre （TMP） raised to 350--400 mmHg and avoiding the use of heparin that might interfere with polymerase chain reaction （PCR） results. Two samples of each patient, altogether 20 ultrafiltrate samples were tested by RT-PCR assay to detect HCV-RNA marker. RESULTS In stage I , 20 samples of the ultrafiltrate from 20 patients with low flux dialyzers were totally tested to be HCV RNA-negative. In stage Ⅱ , 2 of 20 samples, which came from a same patient, were found HCV RNA- positive. CONCLUSIONS Passage of HCV escaping out of the membrane is possible to exist under the extreme condition of high value of TMP and employing high flux dialyzers.