抗HCV筛查血液透析患者丙型肝炎病毒感染的风险

Risk of anti HCV screening for hepatitis C virus infection in hemodialysis patients

目的研究单测丙型肝炎病毒抗体(抗-HCV)的模式与血液透析患者中丙型肝炎病毒(HCV)漏检率的关系,探讨丙型肝炎病毒核心抗原(HCV-c Ag)检测作为降低血液透析患者丙型肝炎病毒感染风险的可行性。方法经ELISA法检测抗-HCV均为阴性的181例血液透析患者作为研究对象,分别于90 d、180 d同时ELISA法检测抗-HCV和HCV-c Ag,其阳性标本采用荧光定量逆转录聚合酶链反应法(RT-PCR)进行HCV-RNA确认。结果181例血液透析组中HCV漏检9例(漏检率4.97%),外科手术组HCV漏检1例(漏检率0.55%),差异有统计学意义(P<0.05);11例HCV核心抗原阳性标本确认10例HCV-RNA阳性,阳性符合率90.9%(10/11)。随访对象第90天、180天,联合检测(抗-HCV和HCV-c Ag)阳性率分别为5.52%和6.08%,抗原抗体同时出现阳性的比率分别为30%和36%。结论联合HCV-c Ag检测有益于提高血液透析患者的阳性检出率,降低透析进程中患者之间丙型肝炎病毒交叉感染的风险。

Objective To study the correlation between patterns of single test of hepatitis C virus antibody（anti -HCV） and miss rate of hepatitis C virus（HCV）in hemodialysis patients,to explore the core antigen of hepatitis C virus （HCV- cAg） detection as the feasibility to reduce the risk of hepatitis C virus infection in hemodialysis patients. Methods Se- lected 181 hemodialysis patients as the research subjects,whose anti-HCV tests were shown as negative through the method of ELISA. In 90 days and 180 days,ELISA method was used to detect the anti-HCV and HCV-cAg. Positive samples by fluorescence quantitative reverse transcription polymerase chain reaction（RT-PCR）were detected by HCV- RNA. Results HCV had 9 cases missed detection in 181 hemodialysis group （miss rate 4.97% ）; Surgical operation group was 1 case （miss rate 0.55%）.The difference of the two groups by X2 test was significant（P〈0.05）; 11 cases of HCV core antigen positive samples were confirmed to 10 cases of HCV-RNA positive,the positive coincidence rate was 90.9% （10/11）. Subjects were followed up for the 90th day and the 180th day,the combined detection of anti-HCV and HCV-cAg positive rates were 5.52% and 6.08%. The antigen and the antibody appeared at the same time the posi- tive rates were 30% and 36%. Conclusion Combined detection of HCV-cAg is helpful to improve the positive rate of hemodialysis patients,and reduce the risk of hepatitis C virus infection.