长期血液透析患者并发HCV感染的危险因素及其病毒基因分型

Viral genotypes and risk factors for HCV infection in patients undergoing long-term hemodialysis

目的分析长期血液透析(HD)患者并发丙型肝炎病毒(HCV)感染的危险因素及其病毒基因分型。方法回顾性选取2018年12月-2020年12月两家医院行长期HD治疗后并发HCV感染的80例患者为感染组,另选择同期在医院行长期HD治疗后未并发HCV感染的80例患者为未感染组。采用sanger测序法检测HCV基因型,将两组患者各项临床资料进行单因素分析比较,Logistic回归分析影响长期HD患者并发HCV感染的危险因素。结果80例长期HD并发HCV感染患者以单基因型(92.50%)为主,其中以1b基因型(48.75%)、2a基因型(42.50%)为主;长期HD并发HCV感染与患者的糖尿病史、肾移植史、输血次数、透析时间、低蛋白血症有关(P<0.05);感染组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、C-反应蛋白(CRP)水平高于未感染组(P<0.05),白蛋白(ALB)水平低于未感染组(P<0.05);Logistic回归分析显示,糖尿病史、透析时间>3年、多次输血均为影响长期HD患者并发HCV感染的危险因素。结论对于需行长期HD治疗的患者,存在糖尿病史、输血史、透析时间>3年的患者是发生HCV感染的高危人群。

OBJECTIVE To investigate the viral genotypes of long-term hemodialysis patients complicated with hepatitis C virus(HCV)infection and analyze the risk factors.METHODS From Dec 2018 to Dec 2020,a total of 80 patients who underwent long-term hemodialysis in the tow hospitals and were complicated with HCV infection were assigned as the infection group,meanwhile,80 patients who underwent long-term hemodialysis but were not complicated with HCV infection were assigned as the no infection group.The genotypes of HCV were detected by using sanger sequencing method,univariate analysis was performed to compare the clinical data between the two groups of patients,and logistic regression analysis was carried out for the risk factors for the HCV infection in the long-term hemodialysis patients.RESULTS Of the 80 long-term hemodialysis patients complicated with HCV infection,92.50%were single genotype,48.75%of whom were 1 b genotype,and 42.50%were 2 a genotype.The complication of HCV infection in the long-term hemodialysis patients was associated with history of diabetes mellitus,history of kidney transplantation,number of times of transfusion,time of dialysis and hypoalbuminemia(P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and C-reactive protein(CRP)of the infection group were significantly higher than those of the no infection group(P<0.05),the albumin(ALB)level of the infection group was significantly lower than that of the no infection group(P<0.05).Logistic regression analysis showed that the history of diabetes mellitus,more than 3 years of dialysis and frequent transfusion were the risk factors for the complication of HCV infection in the long-term hemodialysis patients.CONCLUSION Among the long-term hemodialysis patients,the patients with history of diabetes mellitus,history of transfusion and time of dialysis more than 3 years are the groups at high risk of HCV infection.