中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (03): 168-172.doi: 10.3969/j.issn.1671-4091.2023.03.003

• 临床研究 • 上一篇    下一篇

合并血源性传染病的血液透析患者传染病治疗现状调查

赵娜新   董庆华   曾志立   刘海燕   任雯雯   向 攀   

  1. 100015 北京， 1首都医科大学附属北京地坛医院肾内科 新发突发传染病研究北京市重点实验室
  • 收稿日期:2022-11-01 修回日期:2023-01-12 出版日期:2023-03-12 发布日期:2023-03-03
  • 通讯作者: 向攀 E-mail:Xiangpanbj@163.com

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

ZHAO Na-xin, DONG Qing-hua, ZENG Zhi-li, LIU Hai-yan, REN Wen-wen, XIANG Pan   

  1. Department of Nephrology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2022-11-01 Revised:2023-01-12 Online:2023-03-12 Published:2023-03-03
  • Contact: 100015 北京，1首都医科大学附属北京地坛医院肾内科 新发突发传染病研究北京市重点实验室 E-mail:Xiangpanbj@163.com

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摘要： 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。

关键词: 血液透析, 乙型肝炎病毒, 丙型肝炎病毒, 人类免疫缺陷病毒, 梅毒

Abstract: 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 blood-borne 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.

Key words: Hemodialysis; , Hepatitis B virus, Hepatitis C virus; , Human immunodeficieney virus；Syphilis

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