维持性血液透析患者血液乙型肝炎表面抗原阳性的危险因素及对肝功能的影响

Serum hepatitis B virus surface antigen in maintenance hemodialysis patients:its risk factors and its effect on liver function

目的观察维持性血液透析患者乙型肝炎病毒(HBV)感染的流行病学和乙型肝炎病毒表面抗原(HBsAg)对患者肝功能的影响,探讨HBV感染的危险因素。方法回顾性分析2008年12月到2009年3月在上海交通大学附属第一人民医院肾内科维持性血液透析超过6月的301例患者的临床资料,患者透析时间6～372月,平均血液透析时间(64.13±61.00)月。所有患者每半年复查一次乙型病毒性肝炎(乙型肝炎)病毒指标,并分为HBsAg阳性组和HBsAg阴性组。患者血液透析前用第二代酶联免疫吸附法(ELISA)测定HBV感染指标,自动生化仪测定肝功能,血球分析仪测定血常规。结果301例维持性血液透析患者,HBsAg阳性20例(6.64%),如果包括乙型肝炎感染其他指标(HBVM任何一项)则血液透析患者感染率是42.52%,其中5例(25.00%)有输血史,HBsAg阴性患者中6例(2.14%)有输血史。logistic多元回归分析提示,输血与乙型肝炎表面抗原阳性存在相关性(r=16.597,P<0.05)。结论血液透析患者随着输血次数的增加乙型肝炎感染率提高,HBsAg阳性对血液透析患者肝功能影响并不显著,其乙型肝炎相关并发症也少见。定期检测及对HBsAg阳性患者采取严格的隔离措施,是预防透析中心乙型肝炎感染的重要措施之一。

Objective To study the prevalence of hepatitis B virus （HBV） infection, liver function changes by the infection, and the risk factors of the infection in maintenance hemodialysis （MHD） patients. Methods We retrospectively analyzed 301 MHD patients treated for more than 6 months in Shanghai First People＇s Hospital Affiliated to Jiaotong University from December 2008 to March 2009. Their hemodialysis period lasted 6-372 months （64.13 ± 61.00 months）. The indicators for HBV infection were examined every half a year for all patients. We divided the patients into HBsAg positive and HBsAg negative groups. Before the beginning of hemodialysis, we assayed HBV by the second generation enzyme linked immunosorbent assay （ELISA）, liver functions by an automatic biochemical analyzer, and blood routine tests by a blood cell analyzer. Results In the 301 cases, serum HBsAg was found in 20 cases （6.64%）; but the infection rate increases to 42.52% if patients with one or more than one HBV infection markers （HBVM） were included. Five HBsAg positive pa- tients （25.00%） and 6 HBsAg negative patients （2.14%） had the history of blood transfusion. Logistic analysis showed that blood transfusion was significantly correlated with patients with serum HBsAg （r = 16.597, P = 0.000）. In HBsAg positive patients, one had liver cirrhosis, and one turned to be negative later. Positive HBsAg did not affect liver function and the quality of dialysis in MHD patients. Conclusions In this cohort of MHD patients, the rate of positive serum HBsAg was 6.64%. Blood transfusion increased the rate of HBV infection. HBV infection had less effect on liver function and complications in these patients. Regular detection of HBV infection and strict isolation measures are essential for the prevention of HBV infection in MHD patients.