中国血液净化

›› 2011, Vol. 10 ›› Issue (8): 429-432.doi: 10.3969/j.issn.1671-4091.2011.08.00

• 临床研究 • 上一篇    下一篇

血液透析人群丙型肝炎病毒感染的多中心临床研究

张小丽 朱 蓓 喻荣彬 赵卫红   

  1. 南京医科大学第一附属医院老年肾科; 南京医科大学流行病与卫生统计学系
  • 收稿日期:2010-12-07 修回日期:1900-01-01 出版日期:2011-08-12 发布日期:2011-08-12
  • 通讯作者: 赵卫红

Clinical and multi-center research on hepatitis C infection in hemodialysis patients

ZHANG Xiao-li, ZHU Bei, YU Rong-bin, ZHAO Wei-hong   

  1. 1Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; 2Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
  • Received:2010-12-07 Revised:1900-01-01 Online:2011-08-12 Published:2011-08-12

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摘要：

目的 探讨多中心维持性血液透析(maintenance hemodialysis,MHD)人群丙型肝炎病毒(hepatitis C virus,HCV)感染的发生率、危险因素以及血清转氨酶水平的变化。 方法 采集多中心MHD患者病史、输血史、肾移植史等临床资料，检测丙氨酸氨基转移酶(alanine transaminase,ALT)、天冬氨酸氨基转移酶(aspartate transaminase,AST)、抗HCV抗体及HCV-RNA。 结果 796例透析患者抗HCV抗体阳性176例(22.1%)，其中HCV-RNA阳性142例(80.7%)。单因素分析表明，MHD患者的HCV感染与透析时间、输血率、透析器复用率及肾移植有关(均P＜0.05)。多因素logistic回归分析提示透析时间(OR=1.38,95%CI=1.24～1.53,P＜0.01)和透析器复用史(OR=10.91,95%CI=5.52～21.55,P＜0.01)是HCV感染的独立危险因素。HCV感染组和HCV未感染组的ALT水平分别为(25±30)U/L和(12±13)U/L，AST水平分别为(24±20)U/L和(16±14)U/L，差异均有统计学意义(均P＜0.01)。HCV感染组和HCV未感染组的ALT异常增高率分别为17.0%(30/176)和2.4%(15/620)，AST异常增高率分别为10.5%(18/171)和4.8%(29/608)，差异均有统计学意义(均P＜0.01)。 结论 抗HCV抗体阳性的透析患者可进一步检测HCV-RNA以判断其活动性；监测血清转氨酶水平虽不宜作为判断血液透析患者HCV感染的敏感指标，但可作为了解肝损害的指标；针对MHD患者应当采取综合措施，控制HCV的传播，降低感染率。

关键词: 丙型肝炎, 血液透析, 转氨酶, 危险因素

Abstract:

Objective The aim of this study was to investigate the incidence of hepatitis C virus (HCV) infection and the risk factors for the infection in maintenance hemodialysis (HD) patients from multiple centers in Jiangsu province. We also measured serum aminotransferase level in these patients. Methods Clinical data of these patients, including demographical information, history of blood transfusion and kidney transplantation, were recorded. Liver biochemistry tests including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured. Anti-HCV antibody was assayed by enzyme-linked immunosorbent assay (ELISA), and HCV-RNA was detected by real-time polymerase chain reaction (RT-PCR) method. Results (a) Positive anti-HCV antibody was found in 22.1% (176/796) HD patients, and HCV-RNA was found in 80.7% (142/176) patients with positive anti-HCV antibody. (b) Univariate analysis of HCV infected and non-HCV infected patients indicated that the HCV infection was associated with longer duration on hemodialysis (7.13±4.60 vs. 2.73±3.01 year, P＜0.001), blood transfusion (64.2% vs. 45.5%, P＜0.001), dialyzer reuse (51.3% vs. 7.9%, P＜0.001) and kidney transplantation (11.0% vs. 3.5%, P=0.003). Moreover, logistic analysis revealed that longer duration on hemodialysis (OR=1.38, 95% CI=1.24-1.53, P＜0.001) and dialyzer reuse history (OR=10.91, 95% CI=5.52-21.55, P＜0.001) were the independent risk factors for HCV infection. (c) Despite the normal range of average aminotransferase level in HCV infected patients, the average aminotransferase level and the rate of abnormal aminotransferase level were significantly higher in HCV infected patients than in non-HCV infected patients. Conclusions (a) HCV-RNA detection is required in HD patients with positive anti-HCV antibody for the estimation of HCV activity. (b) Serum aminotransferase level may be an insensitive marker for the diagnosis of HCV infection in HD patients, but is useful for the evaluation of hepatitis activity and hepatocytic injury. (c) Comprehensive interventions should be taken to control HCV transmission in HD patients.

Key words: Hemodialysis, Serum aminotransferase, Risk factors