重复献血者HBV窗口期残余风险评估及趋势研究

HBV infection in window period among repeated blood donors: Residual risk assessment and trend analysis

目的为了了解血液安全状况以及评估血液安全预防措施的实施效果。方法以上海市采供血信息系统中2018~2020年期间上海奉贤血站的数据为例,在数据挖掘的基础上,对重复献血者HBsAg转阳标本进行确证及补充血清学检测,获得献血间隔期内的新感染人数。利用重复献血者献血间隔期转阳模型,评估HBV的发病率和残余风险,并将2002~2005年、2007~2010年、2011~2013年和2018~2020年的评估结果进行趋势比较。结果 2018~2020年间重复献血者在献血间隔期内的新感染者共有9人,发病率为万分之2.72。如果只开展HBsAg血清学筛查,窗口期残余风险为1∶30 637,而增加HBV核酸检测(NAT)血液筛查以后,残余风险降至1∶73 529,与HBsAg筛查相比较,NAT血液筛查能降低58.33%的残余风险。2002~2020年期间,不同研究时间段的残余风险处于下降趋势,与2002~2005年间的评估结果比较,2018~2020年重复献血者捐献的血液传播HBV的窗口期残余风险大幅降低了1个数量级。结论输血传播HBV的残余风险呈下降态势,NAT能大幅降低该风险,但进一步风险降低还需要加强乙型肝炎的综合防控措施。

Objective To investigate the status of blood safety and the effectiveness of preventive measures. Methods The data of Fengxian Blood Bank from 2018 to 2020 were extracted from Shanghai blood collection and supply information system. HBsAg sero-conversion samples of repeated blood donors were confirmed, and HBV serologic supplemental test were performed to obtain the number of new infections during the blood donation interval. The incidence and residual risk of HBV infection were evaluated by the sero-conversion model in donation intervals for repeated donors, and residual risk trend between the study period of 2002 to 2005, 2007 to 2011, 2011 to 2013 and 2018 to 2020 was compared. Results During 2018~2020, nine new HBV infections occurred among repeated donors during blood donation interval, with an incidence rate of 2.71 per 10 000. The residual risk of window period HBV transmission by transfusion could be reduced by 58.33% using HBsAg test plus NAT(HBsAg test 1∶30 637 vs HBsAg test plus NAT 1∶73 529).The residual risk of HBV transmission was decreasing when stratifying by periods, especially one order of magnitude dropped in 2018~2020 as in comparison of 2002 to 2005. Conclusion The residual risk of HBV transmission by transfusion showed a decrease trend. Although NAT could greatly reduce the risk, comprehensive preventive measures are needed to further reduce the risk.