手术前和输血前血液传播性疾病感染因子检测及意义

Detection and significance of blood transmitted infective agents before operation and transfusion

目的:通过对手术前和输血前患者乙肝5项、HCV、HIV、TP等血液传播性疾病感染因子标记物及ALT检测,探讨其在医院感染控制、化解医疗风险和减少医疗纠纷中的作用。方法:采用ELISA法检测19 592例手术前和输血前患者乙肝5项指标、丙型肝炎病毒抗体(抗-HCV)、艾滋病病毒抗体(抗-HIV)、梅毒螺旋体抗体(抗-TP),谷丙转氨酶(ALT)采用速率法。结果:单项HBsAg阳性率为16.09%,HBsAg加HBeAg阳性率1.62%,HBsAg加HBeAg加HBcAb阳性率7.16%,HBsAg加HBeAb加HBcAb阳性率8.49%,HBsAg加HBcAb阳性率0.51%,单项HBeAb阳性率0.59%,单项HBcAb阳性率4.76%;HBV总阳性率为38.92%。抗-HIV阳性率0.087%;抗-TP阳性率0.74%;抗-HCV阳性率1.27%;4898例ALT>40 U/L,阳性率25%。17例抗-HIV阳性病例中HIV重叠感染HBV 7例(41.18%);HIV重叠感染HCV 3例(17.65%);HIV同时感染HCV和HBV三重感染2例(11.76%)。结论:①手术前和输血前进行相关感染疾病标记物的检测对防范手术和输血风险是十分必要的。②要加大经费和技术投入,最大限度的选用灵敏度高、重复性好的试剂和仪器,尽可能的采用能缩短"窗口期"的试剂,进一步提高检出率,才能有效地减少输血和手术医疗风险和纠纷的发生。

Objective：To detect blood transmitted disease infective markers such as five indexes of hepatitis B,HCV,HIV,TP and ALT in patients before operation and transfusion and discuss the its effect on hospital infective control,defusing medical risk and reducing medical disputes.Methods：Five indexes of hepatitis B,anti-HCV,anti-HIV and anti-TP were detected by ELISA,and ALT was detected by kinetic method.Results：The positive rates of HBsAg,HBsAg plus HbeAg,HBsAg,HbeAg plus HbcAb,HBsAg,HBeAb plus HBcAb,HBsAg plus HBcAb,HBeAb and HbcAb were 16.09%,1.62%,7.16%,8.49%,0.51%,0.59% and 4.76%.The total positive rate of HBV was 38.92%.The positive rates of anti-HIV,anti-TP and anti-HCV were 0.087%,0.74% and 1.27%.4898 patients had ALT 〉40 U/L,with the positive rate of 25%.Among 17 anti-HIV positive cases,7 cases had overlapping infection of HBV（41.18%）,3 cases had overlapping infection of HCV（17.65%）and 2 cases had triple infection of HIV,HCV and HBV（11.76%）.Conclusion：①It would be necessary to detect infective markers and ALT before operation and transfusion to avoid operation and transfusion risk.②It would be important to increase fund and technology input to choose reagent and instrument with high sensitivity and good repeatability and reagents which could shorten window period and improve detection rate to reduce the risk of operation,transfusion and medical disputes.