上海地区638例输血后丙型肝炎病毒感染者的临床分析

Clinical characteristics of 638 patients infected with hepatitis C virus by post blood transfusion, in Shanghai

目的分析输血后丙型肝炎病毒（HCV）感染者的临床特征。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、肝功能损害和腹部超声图像改变等。结果578例感染者中有525例（90．8％）HCVRNA载量≥3．0log10 copy／ml（M=6．10log10copy／ml），其中19．2％病例为3．0～4．0log10copy／ml、66．1％为5．0—6．0log10copy／m1，仪14．7％病例≥7．0log10copy／ml。HCVRNA定性阳性率为81．5％（44／54），HCV基凶型主要为1型，抗-HCV阳性率达99．8％（636／637），其阳性敏感率高于HCVRNA定量和定性检测（均为P=0．000）。输血后HCV感染以40～60岁年龄段多见，85．7％病例的暴露时间为1990—1994年，10％以上的感染者中基础疾病为妇产科、骨科疾病和胃肠道出血，79．9％的病例为输入全血者，输血至临床诊断时间平均（8．5±5．5）年；90．1％感染者有肝功能损害，多数病例血清丙氨酸氨基转移酶（ALT）升高水平≤5×ULN，而血清总胆红素升高、ALT和天冬氨酸氨基转氨酶≥5×ULN水平者临床表现较多（P值分别为0．000、0．001和0．009）；8．9％感染者腹部超声显示有肝硬化改变，但多见于感染期〉5年者。结论输血后HCV感染主要集中于1990—1994年，成年人患病率较高，常伴有肝功能损害，感染期〉5年者肝硬化发生率较高，HCV基因型主要为1型，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 by post blood transfusion. Methods Polymerase chain reaction （PCR） and enzyme linked immunosorbent assay （ELISA） were used to detect HCV RNA and anti- HCV, respectively. Analysis was performed on patients＇ age distribution, cause of primary diseases, years of exposure, ingredient and amount of transfusion, incubation period, disorder on liver function and changes on abdominal ultrasound image, etc. Results HCV RNA levels were higher than 3.0 log10 copy/ml in 90.8% infected patients with a median as 6.10 log10 copy/ml. 19.2% of the patients showed viral load 3.0 to 4.0 log10 copy/ml, and 66.1% of them showed 5.0 to 6.0 log10 copy/ml. Only 14.7% of the infected persons had HCV RNA levels higher than 7.0 log10 copy/ml. Eighty-one point five percent （44/54） of the infected persons were confirmed as HCV RNA positive by HCV RNA qualitative analysis with HCV genotype as primarily type 1. 99.8% （636/637） of the patients were detected as anti-HCV positive by serological test. The sensitivity of serological test was higher than both quantitative and qualitative HCV RNA assays （P=0.000, P=0.000, respectively）. HCV infection post blood transfusion was more seen in common people at 40 to 60 years old. Most cases （85.7%） had their first exposure during 1990 to 1994. More than 10% of the cases had primary diseases as obstetrics, orthopedics or gastrointestinal tract hemorrhage. 79.9% of the patients received whole blood product transfusion. The mean interval between transfusion and clinical diagnosis was 8.5 ±5.5 years. 90.1% of the infected patients had liver function damage, while most of them showed elevated alanine aminotransferase （ALT） no more than 5 upper limits of normal （ULN） , whereas Serum total bilirubin （ TBIL ）, ALT and aspartate aminotransferase （AST） ≥ 5 × ULN level were showing more clinical manifestations （P=0.000, P=0.001, P=0.009, respectively）. Abdominal ultrasound among 8.9% of the infected persons showed changes in cirrhosis, and most of them were older than 50 years of age. Conclusion Most of the post transfusion HCV infected cases happened in adulthood, and were mainly exposed during 1990 to 1994. Infected patients usually had their liver function damaged with elevated ALT no more than 5 × ULN and with medium HCV RNA levels. HCV genotype was mainly for type 1. Patients who were of older age showed higher incidence of cirrhosis. If a patients＇ infection period was longer than 5 years, he/she would show higher incidence of cirrhosis.