Oguchi T, Tanaka E, Orii K, Kobayashi M, Hora K, Kiyosawa K
Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
J Gastroenterol. 1999 Apr;34(2):234-40. doi: 10.1007/s005350050249.
To study the prevalence and clinical significance of TT virus (TTV) infection in hemodialysis patients, we tested for TTV DNA in serum, using the nested polymerase chain reaction. The prevalence of TTV DNA in 352 hemodialysis patients was 32%, significantly higher than that in 50 healthy blood donors (12%). The prevalence increased with age (P = 0.0098): it was 20% (22/110) in patients aged less than 49 years, 37% (69/188) in those aged 50-69 years, and 41% (22/ 54) in those aged over 70 years. Other clinical features and the prevalence of other hepatitis viral markers tested did not differ between patients with TTV DNA and those without it. The detection rate of hepatitis C virus (HCV) and hepatitis G virus (HGV) viremias increased with duration of hemodialysis and with the number of blood transfusion units, but the prevalence of TTV viremia did not. Twenty-nine of 91 patients followed for 5 years were initially positive for TTV DNA. Of these 29 patients, 17 (59%) carried this viremia for at least 5 years. Fourteen of the 62 patients (23%) who were initially negative for TTV DNA acquired TTV viremia. Serum alanine aminotransferase (ALT) levels were elevated in patients with HCV viremia but not in patients with HGV or TTV viremia. However, the mean ALT level in patients with all three viremias (HCV, HGV, and TTV) was significantly higher than that in patients with one or two of the viremias. More than 30% of the hemodialysis patients had TTV viremia and the carrier state was maintained for years. The hemodialysis procedures, including blood transfusion, did not seem to be crucial for the transmission of TTV. The pathogenic effects of TTV on hepatitis appear to be limited.
为研究血液透析患者中丁型肝炎病毒（TTV）感染的患病率及其临床意义，我们采用巢式聚合酶链反应检测血清中的TTV DNA。352例血液透析患者中TTV DNA的患病率为32%，显著高于50名健康献血者（12%）。患病率随年龄增长而升高（P = 0.0098）：年龄小于49岁的患者中为20%（22/110），50 - 69岁的患者中为37%（69/188），70岁以上的患者中为41%（22/54）。TTV DNA阳性患者与阴性患者的其他临床特征以及所检测的其他肝炎病毒标志物的患病率并无差异。丙型肝炎病毒（HCV）和庚型肝炎病毒（HGV）血症的检出率随血液透析时间和输血单位数量的增加而升高，但TTV血症的患病率并非如此。91例随访5年的患者中，29例最初TTV DNA呈阳性。在这29例患者中，17例（59%）至少5年持续存在这种病毒血症。62例最初TTV DNA呈阴性的患者中有14例（23%）感染了TTV病毒血症。HCV血症患者的血清丙氨酸氨基转移酶（ALT）水平升高，但HGV或TTV血症患者并非如此。然而，同时存在三种病毒血症（HCV、HGV和TTV）的患者的平均ALT水平显著高于存在一种或两种病毒血症的患者。超过30%的血液透析患者存在TTV病毒血症，且携带状态可持续数年。包括输血在内的血液透析操作似乎并非TTV传播的关键因素。TTV对肝炎的致病作用似乎有限。
