常熟地区血液透析人群丙型肝炎病毒感染的临床研究

Clinical study of hepatitis C infection in hemodialysis patients in Changshu district

目的探讨常熟市维持性血液透析人群丙型肝炎病毒(HCV)感染的患病率、危险因素以及血清转氨酶水平的变化情况。方法调查对象为常熟市3个血液透析中心维持性血液透析患者229人。采集患者病史、输血史、透析方案等临床资料,同时采集每名调查对象静脉血检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ谷氨酰转肽酶(GGT)、单胺氧化酶(MAO)和抗-HCV抗体,并根据抗-HCV抗体检测结果分为HCV抗体阳性组和HCV抗体阴性组。结果常熟市维持性血液透析人群丙型肝炎病毒(HCV)感染的患病率为6.55%。抗-HCV抗体阳性组与阴性组间性别、年龄无显著差异(P>0.05),阳性组患者维持血液透析时间及输血发生率高于阴性组(P<0.05和P<0.01)。HCV抗体阳性组ALT异常率大于阴性组(P<0.05),但平均ALT、AST水平仍在正常范围,而且抗体阴性组也有5.14%的患者ALT水平异常;HCV抗体阳性组中各有73.3%、84.6%、69.2%的患者血清转氨酶水平(ALT、AST)和GGT仍在正常范围。结论输血史及透析时间是血液透析患者HCV感染的危险因素;血清转氨酶不宜作为血透患者HCV感染的敏感判断指标。

Objective The aim of the study was to observe the prevalence of hepatitis C （HCV） infec- tion, its related risk factors, and changes of serum aminotransferases in maintenance hemodialysis （MHD） pa- tients in Changshu district. Methods We recruited blood samples for blood examinations from 229 MHD patients in 3 hemodialysis centers in Changshu district. Their clinical data including demography, hemodialy- sis duration, blood transfusion history, and laboratory examination results were collected and analyzed. Pa- tients were divided into HCV serologically positive （HCV＋） group and HCV serologically negative （HCV-） group. Results The prevalence of hepatitis C infection in MHD patients in Changshu district was 6.55%, without differences in age and gender between HCV＋ group and HCV- group （P〉0.05）. Hemodialysis dura- tion and the incidence of blood transfusion history were significantly higher in HCV＋ group than in HCV- group （P〈0.05 and P〈0.01, respectively）. The average levels of serum alanine aminotransferase （ALT）, as- partate aminotransferase （AST） and y-glutamyl transpeptadase （GGT） were within the normal ranges in HCV＋ group. Normal ALT, AST and GGT levels were found in 73.3%, 84.6% and 69.2% patients, respective- ly, in HCV＋ group. Conclusions Blood transfusion history and longer hemodialysis duration were the risk factors for HCV infection in MHD patients. The levels of serum aminotransferases may not be the sensitive markers for HCV infection in MHD patients.