维持性血液透析病人感染丙型肝炎的前瞻性研究

Prospective study on hepatitis C virus infection in chronic hemodialysis pationts

目的 评价血液透析（ 血透） 病人 Ｈ Ｃ Ｖ 阳转率和危险因素。方法 随访１９９５ 年６ 月～１９９６ 年１２ 月在本院透析的１９９ 例血透病人，均未隔离抗 Ｈ Ｃ Ｖ 阳性病人。采用敏感的 Ｅ Ｌ Ｉ Ｓ Ａ２ 每隔３ 个月在同一实验室检测。结果 １９９５ 年６ 月的抗 Ｈ Ｃ Ｖ 阳性率为５８ ．７ ％ ，每隔半年的阳性率分别为５３ ．７ ％ 、５４ ．８ ％ 和５０ ．０ ％ 。在１８ 个月随访期间，３１ 例病人阳转；１５６ 例病人随访１ ～６ 个月，阳转１４ 例（８ ．９ ％ ） ，６７ 例病人随访７ ～１２ 个月，１５ 例（２２ ．４ ％ ） 阳转，６ 例病人随访１３ ～１８ 个月，２ 例（３３ ．３ ％ ） 阳转；２ 例病人阳转并转为肝硬化；９ 例阳转病人从未输血。严格的感染预防措施和化学消毒对长期阳性率影响不大，尿毒症病人血透前抗 Ｈ Ｃ Ｖ 阳性率很低，而一旦阳转也无其它措施。结论 透析环境对 Ｈ Ｃ Ｖ 传播有影响，可能或是通过共用透析机，或是由于未隔离阳性病人。

Objective To delineate the incidence and risk factors of dialysis patients for seroconversion (SC) of HCV. Methods From June 1995 to December 1996 we followed up all 199 patients dialyzed in our HD unit, none was isolated from anti HCV positive patients. The sensitive ELISA 2 was performed every three months in the same laboratory for all patients.Results Prevalence rates of HCV antibody of 58.7%、53.7%、54.8% and 50.0% were found in four consecutive six month periods. During the 18 months follow up periods, ELISA 2 became positive in 31 patients; 156 were followed for 1～6 months and 14(8.9%) were SC for HCV; 67 were followed for 7～12 months and 15(22.4%) were SC for HCV; 6 were followed for 13～18 months and 2(33.3%) were SC for HCV; 2 were SC for HCV and developed liver cirrhosis; nine of 31 patients with SC had not received transfusion at all. The application of strict supervised universal infection control techniques and chemical sterilization had no effect on the long term prevalence. The prevalence of HCV antibody among uremic patients before HD was negligible and once the patient became HCV antibody positive, he/she would remain so.Conclusion The dialysis environment is responsible of transmssion of HCV either through the usage of the machines in common or due to non isolation of patients with positive HCV antibody. (Shanghai Med J, 1999,22∶600 602)