维持性血液透析致丙型肝炎病毒感染临床特点分析

The clinical outcome of maintenance hemodialysis patients with hepatitis C viruses infection.

目的探讨维持血液透析致丙型肝炎病毒(HCV)感染的临床特点及转归。方法回顾性分析了2007年12月31日北京大学人民医院透析中心血液透析的99例患者中感染丙型肝炎病毒感染者的临床资料,包括人口学资料、输血情况,与透析相关的感染控制措施及血清转氨酶、胆红素、白蛋白以及HCV RNA、HCV抗体和肝脏B超检测指标等。结果99例维持血液透析患者中有20例感染HCV,患病率为20.2%,其中HCV感染患者的年龄平均为(63.3±10.9)岁,透析龄为(79.9±38.7)个月;发现HCV感染的平均持续时间为(32.6±22.6)个月,其中最长的1例患者为103.5个月。HCV感染者中有16例(80%)感染HCV前有输血史。曾有4例患者血清HCV RNA阳性,其中1例经应用干扰素治疗半年后持续HCV RNA转阴,1例1月后HCV RNA自行转阴,其余2例患者血中HCV RNA仍阳性。抗HCV阳性血液透析患者的年龄及透析龄均明显大于抗HCV阴性者。实行严格感染控制措施后血液透析患者平均每年丙型肝炎病毒感染的新发病例(1.2%)较前(5.3%)明显下降(P<0.05)。Logistic回归分析显示输血(P=0.001)及透析龄(P=0.001)是血液透析患者HCV感染的独立危险因素。结论输血及透析龄是血液透析患者感染HCV的独立危险因素。实行严格感染控制措施可降低血液透析患者HCV感染的患病率。

Objective To observe the clinical outcome of maintenance hemodialysis patients with hepatitis C viruses （HCV） infection. Methods A retrospective investigation about hepatitis C viruses infection was performed in our hemodialysis centre on December 31,2007. The clinical data including demography, serum transaminase, bilirubin, albumin, anti-HCV antibody, HCV RNA, infection-control procedures associated hemodialysis and ultrasound of the liver was analyzed. Results The prevalent rate of HCV infection in our hemodialysis centre was 20. 2% （20/99）, The mean age of maintenance hemodialysis patients with HCV infection was （63. 3 ± 10.9 ）years old, the duration on dialysis was （79. 9 ± 38.7 ）months, and the duration of positive serum anti-HCV was （32. 6 ± 22. 6 ）months（ the longest duration was 103.5 months ）. 16 patients（ 80% ）had blood transfusion history in the patients with HCV infection. Only four cases had viremia of HCV, the serum HCV RNA became negative in one of them spontaneously and in another one after interferon therapy for half a year, the other two of them have viremia now. Most of patients found their serum transaminase elevated transiently and mildly. The age and duration on dialysis of the patients with positive serum anti-HCV were significantly longer than those of patients with negative serum anti-HCV. After strict infection-control procedures were carried out, the new onset cases of HCV infection was significantly decreased （ 1.2% vs 5.3 % , P 〈 0. 05 ）. Blood transfusion （P = 0. 001 ）and duration on dialysis（ P = 0. 001 ）are the independent risk fators of HCV infection in hemodialysis patients by logistic analysis. Conclusion Blood transfusion and duration on dialysis are the independent risk factors of HCV infection in hemodialysis patients. Strict infection-control procedures help to decrease the prevalence of HCV infection in hemodialysis unit.