Transmission of Neurodegenerative Disorders Through Blood Transfusion A Cohort Study
Transmission of Neurodegenerative Disorders Through Blood Transfusion A Cohort Study
复制标题
DOI：
10.7326/m15-2421
复制
发表时间：
2016-09-06
影响因子：
39.2
通讯作者：
Nyren, Olof
中科院分区：
文献类型：
--
作者：
Edgren, Gustaf;Hjalgrim, Henrik;Nyren, Olof
背景：大脑中错误折叠蛋白质的聚集发生在多种神经退行性疾病中。通过脑内接种可在啮齿动物和灵长类动物中诱导异常蛋白质聚集。神经退行性疾病可能的输血传播具有重要的公共卫生影响。目的：调查神经退行性疾病可能的输血传播。设计：回顾性队列研究。背景：瑞典和丹麦的全国输血登记处。参与者：1968 年至 2012 年间接受输血的 1 465 845 名患者。测量：使用多变量 Cox 回归模型来估计任何类型的痴呆、阿尔茨海默病、接受献血者输血后被诊断患有帕金森病的患者与接受健康献血者血液的患者相比。还调查了部分捐献者血液的接受者是否过度发生神经退行性疾病。作为阳性对照，对实施丙型肝炎病毒筛查前后慢性肝炎的传播情况进行了评估。结果：在纳入的患者中，2.9% 的患者接受了被诊断患有所研究的神经退行性疾病之一的捐献者的输血。无论采用何种方法，都没有发现任何这些疾病传播的证据。接受患有痴呆症的献血者的血液与接受健康献血者的血液的接受者发生痴呆的风险比为 1.04（95% CI，0.99 至 1.09）。阿尔茨海默病和帕金森病的相应估计值分别为 0.99（CI，0.85 至 1.15）和 0.94（CI，0.78 至 1.14）。在实施丙型肝炎病毒筛查之前而非之后检测到肝炎传播。 局限性：观察性研究设计，结果不确定，统计功效可能不足。结论：数据没有提供神经退行性疾病传播的证据，表明即使确实发生传播，也是罕见的。
Background: The aggregation of misfolded proteins in the brain occurs in several neurodegenerative disorders. Aberrant protein aggregation is inducible in rodents and primates by intracerebral inoculation. Possible transfusion transmission of neurodegenerative diseases has important public health implications.Objective: To investigate possible transfusion transmission of neurodegenerative disorders.Design: Retrospective cohort study.Setting: Nationwide registers of transfusions in Sweden and Denmark.Participants: 1 465 845 patients who received transfusions between 1968 and 2012.Measurements: Multivariable Cox regression models were used to estimate hazard ratios for dementia of any type, Alzheimer disease, and Parkinson disease in patients receiving blood transfusions from donors who were later diagnosed with any of these diseases versus patients who received blood from healthy donors. Whether excess occurrence of neurodegenerative disease occurred among recipients of blood from a subset of donors was also investigated. As a positive control, transmission of chronic hepatitis before and after implementation of hepatitis C virus screening was assessed.Results: Among included patients, 2.9% received a transfusion from a donor diagnosed with one of the studied neurodegenerative diseases. No evidence of transmission of any of these diseases was found, regardless of approach. The hazard ratio for dementia in recipients of blood from donors with dementia versus recipients of blood from healthy donors was 1.04 (95% CI, 0.99 to 1.09). Corresponding estimates for Alzheimer disease and Parkinson disease were 0.99 (CI, 0.85 to 1.15) and 0.94 (CI, 0.78 to 1.14), respectively. Hepatitis transmission was detected before but not after implementation of hepatitis C virus screening.Limitation: Observational study design, underascertainment of the outcome, and possible insufficient statistical power.Conclusion: The data provide no evidence for the transmission of neurodegenerative diseases and suggest that if transmission does occur, it is rare.