合并血源性传染病的血液透析患者传染病治疗现状调查

Investigation on the treatment status of infectious diseases in hemodialysis patients complicated with blood-borne infectious diseases

目的调查合并血源性传染病的维持性血液透析(maintenance hemodialysis,MHD)患者的传染病治疗现状。方法收集2021年3月~2022年8月于北京地坛医院行MHD的合并乙型肝炎病毒(hepatitis B virus,HBV)、丙型肝炎病毒(hepatitis C virus,HCV)、人类免疫缺陷病毒(human immunodeficieney virus,HIV)、梅毒螺旋体(treponema pallidum,TP)感染的患者的传染病治疗资料,汇总其病毒载量或甲苯胺红不加热血清试验(tolulized red unheated serum test,TRUST)。结果共入组55例患者,男性40例(72.7%)。平均年龄(57.4±11.1)岁。合并HBV感染者27例,16例患者(59.26%)已接受抗HBV治疗,全部HBV感染者中9例(33.33%)血清HBV-DNA高于检测下限。合并HCV感染者9例,6例患者(66.67%)已经或正在接受抗HCV治疗,全部HCV感染者血清HCV-RNA均检测不到。合并TP感染者21例,其中2例患者同时合并HBV感染,另外2例患者同时合并HIV感染。2例患者TRUST自行转阴,余19例患者(90.48%)均曾予青霉素治疗,5例患者(23.81%)甲苯胺红不加热血清试验(tolulized red unheated serum test,TRUST)为高滴度。合并HIV感染者2例,均已接受抗病毒治疗,血清HIV-RNA均检测不到,其中1例患者曾发生重症药物性肝炎。结论合并血源性传染病的MHD患者的传染病治疗有待进一步优化。需要多学科间交流合作,采取安全有效的措施,最大限度地降低其血液的传染性。

Objectives To investigate the status of infectious disease treatment in maintenance hemodialysis(MHD)patients with blood-borne infectious diseases.Methods The treatment data of infectious disease in MHD patients with hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV),or treponema pallidum(TP)infection in Beijing Ditan Hospital by August 2022 were collected.And the data of viral load or tolulized red unheated serum test(TRUST)were summarized.Results A total of 55 patients were enrolled,including 40 males(72.7%).The average age was 57.4(±11.1)years.There were 27 patients with HBV infection.16(59.26%)patients have received anti-HBV treatment,and 9(33.33%)patients with HBV infection have serum HBV-DNA higher than the detection limit.There were 9 patients with HCV infection,and 6(66.67%)patients had received or were receiving anti-HCV treatment.Serum HCV-RNA was not detected in all patients with HCV infection.There were 21 patients with TP infection,including 2 patients with HBV co-infection and 2 patients with HIV co-infection.TRUST turned negative in 2 patients without any treatment,and the remaining 19(90.48%)patients had been treated with penicillin,and 5(23.81%)patients had high titer of TRUST.There were 2 HIV-infected patients,all of whom had received antiviral treatment(ART),and their serum HIV-RNA could not be detected.One of them had severe drug-induced hepatitis after the initial ART.Conclusions The treatment of infectious diseases among MHD patients with bloodborne infectious diseases needs to be further optimized.Multi-disciplinary communication and cooperation are needed to take safe and effective measures to minimize the infectivity of blood.