兰州市血液透析患者乙型肝炎病毒感染的危险因素

Analysis of the risk factors of hepatitis B virus infection in hemodialysis patients in Lanzhou

目的探讨兰州市血液透析患者乙型肝炎病毒(Hepatitis B virus,HBV)感染的危险因素。方法对兰州市五家医院血透门诊血透患者问卷调查,收集患者一般人口学资料、既往病史、血液透析过程相关因素、HBV病毒感染检测资料,对数据进行单因素及广义估计方程模型分析。结果共调查565例血液透析患者,其中HBV阳性31例,感染率为5.49%。广义估计方程模型分析显示使用血液制品(1 998年以前OR=8.077,95%CI:3.469~18.803;1998年以后OR=2.678,95%CI:1.719~4.170)、输血(1 998年以前OR=5.344,95%CI:2.212~12.910)、透析龄/月(OR=1.008,95%CI:1.002~1.014)、创伤性美容(OR=1.954,95%CI:1.015~3.766)、文化程度低(OR=3.564,95%CI:1.881~6.753)使透析患者感染HBV的风险提高;年龄>40岁(OR=0.214,95%CI:0.064~0.712)的血液透析患者相对于25岁以下患者乙型肝炎病毒表面抗原(hepatitis B surface antigen, HBsAg)阳性率较低。结论使用血液制品、输血、透析龄越长、创伤性美容和文化程度低能增加血透患者感染HBV风险,在临床中应格外重视血液和血液制品管理和使用,规范透析操作,加强乙型肝炎防治宣传工作。

Objective To explore the risk factors of hepatitis B virus infection in hemodialysis patients. Methods The patients in hemodialysis center of five hospitals in Lanzhou were interviewed through a questionnaire survey. The data of social demography,medical history,hemodialysis process and laboratory test of HBV were collected and analyzed by univariate and Generalized Estimating Equation ( GEE) model analysis. Results Among total 565 investigated hemodialysis patients,31 were HBV positive, with the infection rate of 5. 49%. The result of GEE analysis indicated that using blood products ( before 1998: OR = 8. 077, 95% CI: 3. 469-18. 803;after 1998: OR = 2. 678, 95% CI: 1. 719-4. 170), blood transfusion ( before 1998: OR = 5. 344,95% CI: 2. 212-12. 910),dialysis time ( OR = 1. 008, 95% CI: 1. 002-1. 014),surgical cosmetology( OR = 1. 954,95% CI: 1. 015-3. 766) and poor educational background ( OR = 3. 564,95% CI: 1. 881-6. 753) were risk factors of HBV infection in hemodialysis patients. Compared to hemodialysis patients aged 25 years old and younger,those aged 40 years ( OR = 0. 214, 95% CI: 0. 064 - 0. 712) and above had a lower HBsAg positive rate. Conclusions Using blood products,blood transfusion before 1998,dialysis time,surgical cosmetology and poor educational background can increase the risk of HBV infection;poor educational background increases the risk of HBV infection in the hemodialysis patients. More attention should be paid on the management and usage of blood and blood products in clinical treatment. Dialysis operation should be standardized and propaganda of HBV prevention should be strengthened.