维持性血液透析患者感染丙型病毒性肝炎126个月随访研究

Hepatitis C virus infection in uremic patients on maintenance hemodialysis:a follow-up study for 126 months

目的评价血液透析患者感染丙型肝炎病毒(HCV)的阳转率和危险因素。方法随访1998年6月～2008年12月在上海交通大学附属第六人民医院肾内科进行的血液透析患者,共检测2080例次血液透析患者,采用ELISA法每隔6月在同一实验室检测抗-HCV。结果1998年6月的抗HCV阳性率为54.7%,每隔半年的阳性率分别为53.8%、52.6%、53.0%、51.2%、45.9%、45.5%、48.2%、35.6%、33.7%、33.7%、31.7%、30.4%、28.4%、27.2%、24.5%、20.8%、19.4%、16.6%、14.4%、15.3%和15.2%。在1～126个月随访期间,总计225例患者阳转,随访1～12月者阳转率为4.5%,13～24月者为6.9%,25～48月者为11.9%,49～60月者28.1%,61～72月者35.1%,73～84月者38.6%,85～96月者阳转率46.9%,97～108月者56.3%,109～126月者63.6%;58例患者阳转而从未输血。结论结果提示透析环境对HCV传播有影响,可能一方面通过共用透析机,一方面是由于未隔离阳性患者;严格的消毒隔离措施对降低HCV感染和阳转有重要作用。

Objection To delineate the incidence and risk factors for sero-conversion to positive anti- HCV antibody in maintenance hemodialysis （HD） patients. Methods From June 1998 to December 2008, 2080 HD patients in our hemodialysis unit were followed up, and anti-HCV antibody assay by ELISA was performed every 6 months in the same laboratory. Results From results of the 22 assays at an interval of 6 months for every patient, the sequential prevalence rate of anti-HCV antibody was 54.7%, 53.8%, 52.6%, 53.0 %, 51.2%, 45.9%, 45.5%, 48.2%, 35.6%, 33.7%, 33.7%, 31.7%, 30.4%, 28.4%, 27.2%, 24.5%, 20.8%, 19.4%, 16.6%, 14.4%, 15.3% and 15.2%. During the follow-up period for 126 months, anti-HCV antibody became positive in 225 patients, of whom 58 had not been treated with transfusion. Sero-conversion to positive anti-HCV antibody was found in 49 （4.5%） of the 1086 patients followed up for 1-12 months, in 29 （6.9%） of the 421 patients followed up for 13-24 months, in 35 （11.9%） of the 196 patients followed up for 25-48 months, in 32 （28.1%） of the 114 patients followed up for 49-60 months, in 27 （35.1%） of the 77 patients followed up for 61-72 months, in 22 （38.6%） of the 57 patients followed up for 73-84 months, in 15 （46.9%） of the 32 patients followed up for 85-96 months, in 9 （56.3%） of the 16 patients followed up for 97-108 months, and in 6 （54.5%） of the 11 patients followed up for 109-126 months. Conclusion Hemodialysis may be responsible for the HCV transmission either due to the common use of a dialysis machine or to the unawareness of isolation procedures for HCV-infected patients. Therefore, sterilization manipulations and strict isolation for HCV-infected patients are of great importance for the prevention of HCV transmission among hemodialysis patients.