Is Dialysis Environment More Important Than Blood Transfusion in Transmission of Hepatitis C Virus during Hemodialysis?
Is Dialysis Environment More Important Than Blood Transfusion in Transmission of Hepatitis C Virus during Hemodialysis?
复制标题
血液透析期间丙型肝炎病毒传播中，透析环境比输血更重要吗？
DOI：
10.1111/j.1423-0410.1993.tb02176.x
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发表时间：
1993
期刊：
影响因子：
2.7
通讯作者：
A. Koshy
中科院分区：
文献类型：
--
作者：
M. Kapoor;K. El;S. Al‐Mufti;Nabeel A. Sanad;A. Koshy
丙型肝炎病毒（HCV）通过肠外传播，在血液透析患者中经常发现HCV抗体（抗HCV）。据报道，血液透析患者中抗hcv的患病率从英国的1%[1]到巴西的50%[1]不等。抗hcv阳性的频率与透析时间和输血次数相关。然而，这两种可能的传播方式的相对重要性尚不清楚。我们评估了抗丙型肝炎病毒（ELISA，第二代，雅培，芝加哥，伊利诺伊州）的流行情况。（美国）在献血者和血液透析患者中进行的一项研究，目的是确定输血和血液透析持续时间对获得抗丙型肝炎病毒的相对重要性。只有反复反应的样品才被定义为真正阳性。1992年4月至10月期间，对14,548名献血者和94名血液透析1-144个月(m)的患者进行了研究（表1）。94例患者中有67例（71%）呈抗- hcv阳性。40/67（60%）抗- hcv阳性患者和18/27（67%）抗- hcv阴性患者输血次数为1 ~ 13次（x2 = 0.4， NS）。58例接受输血的患者中，抗- hcv阳性（3.052.2）和抗- hcv阴性（2.2k1.4）患者的输血次数无差异。抗- hcv阳性患者透析时间（46+37m, MkSD）长于抗- hcv阴性患者（22+ 22m）， t = 3.7, p< 0.01。在无抗- hcv的情况下，35/67（52%）患者ALT升高，alcv阳性，3127（11%）患者alcv升高（x′= 13.5;p< 0.01）。丙肝病毒抗体阳性（32+6 g/l）和阴性（31k5 g/l）患者的丙肝球蛋白水平相似。在我们的血液透析患者中发现的抗hcv患病率是最高的。几个因素可能导致高血清患病率。一些患者可能通过输血获得抗丙型肝炎病毒。科威特献血者的血清阳性率为2.4%，高于欧洲和美国。然而，由于输血量与抗- hcv血清阳性率无关，其他因素一定更为重要。此外，40%的抗丙肝病毒阳性患者从未接受过输血。抗hcv阳性患者血液透析时间明显长于抗hcv阳性患者
Hepatitis C virus (HCV) is transmitted parenterally, and antibody to HCV (antiHCV) is frequently found in patients on hemodialysis. The prevalence of anti-HCV in hemodialysis patients has been reported to range from 1% in the UK [l] to 50% in Brazil [2]. The frequencyofanti-HCVpositivityhas been correlated both to the durationof dialysis and number of blood transfusions received [3]. However, the relative importance of these two possible modesof transmissionis not clear. We have assessed the prevalence of antiHCV (ELISA, second generation, Abbott, Chicago, Ill., USA) in blood donors and patients on hemodialysis with a view to determine the relative importance of blood transfusion and duration of hemodialysis in acquiring anti-HCV. Only repeatedly reactive samples were defined as truly positive. 14,548 blood donors and 94 patients, on hemodialysis for 1-144 months (m), were studied between April and October 1992 (table 1). Anti-HCV was positive in 67/94 (71%) patients. 40/67 (60%) anti-HCV-positive patients and 18/27 (67%) anti-HCV-negative patients received 1-13 blood transfusions (x2 = 0.4, NS). Among the 58 patients who received blood transfusions, there was no difference in the number of blood transfusions received between anti-HCV positive (3.052.2) and anti-HCV negative (2.2k1.4) patients. Anti-HCV positive patients were on dialysis for longer duration (46+37m, MkSD) than anti-HCV negative patients (22+22 m) t = 3.7, p<O.Ol. 35/67 (52%) had elevation of ALT and positive anti-HCV while only 3127 (11%) had elevation of ALTin the absence of anti-HCV (x’= 13.5; p<O.Ol). Gamma globulin levels were similar in antiHCV positive (32+6 g/l) and negative (31k5 g/l) patients. The prevalence of anti-HCV found in our patients on hemodialysis is the highest reported. Several factors may have contributed to the high seroprevalence. Some patients may have acquired anti-HCV through blood transfusions. The seroprevalence among blood donors in Kuwait was found to be 2.4%, which is higher than in Europe and the USA. However, since the receipt of blood transfusions was not correlated to seroprevalence of anti-HCV, other factors must have been more important. Furthermore, 40% of the anti-HCV positive patients had never received blood transfusion. Patients who were anti-HCV positive were on hemodialysis for significantly longer period than patients who