González-Michaca L, Mercado A, Gamba G
Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de la Nutrición Salvador Zubirán.
Rev Invest Clin. 2000 May-Jun;52(3):246-54.
The prevalence of hepatitis C in patients with end stage renal disease, under renal replacement therapy either with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), is higher than in the general population. The prevalence of hepatitis C in patients under dialysis, however, is unknown in Mexico. Thus, the major goals of the present study were to determine the prevalence of hepatitis C in our patients on dialysis, and the risk factors associated with it.
We performed a cross-sectional and comparative study in patients under dialysis in three hospital centers in the south of Mexico City. For every patient we evaluated: age, gender, etiology of the renal failure, modality and time in dialysis, transfusion and surgical history, serum albumin, aminotranferases, BUN, and serum creatinine. The presence of hepatitis C was assessed by ELISA II and qualitative RT-PCR in blood samples. In all patients diagnosed as having hepatitis C, RT-PCR to amplified part of the virus genome was also carried out in the dialysis fluid.
We studied 235 dialysis patients that were classified according to their dialysis modality in: 132 patients under CAPD, 17 under CAPD and history of HD (PD/HD) and 86 under HD. The time under dialysis was different between the study groups: CAPD 29.6 +/- 22.3 months, PD/HD 39 +/- 42.3 and HD 14.2 +/- 15.6 (p < 0.01). The presence of hepatitis C was detected in 24 of the 235 patients, for a global prevalence of 10.2%. In no case was viral RNA found in the dialysis fluid. The prevalence varied, however, according to the type of dialysis. It was in the CAPD group 4.5%, 12.7% in the HD group, and 41.1% in the PD/HD group (p < 0.001). The multivariate analysis showed that the risk factors for hepatitis C are transfusions before the year of 1991 (Odds Ratio = 6.4), and history of hepatitis (OR = 4.3). Since less patients are seen with transfusions before 1991, we constructed another model in which this variable was excluded. This new multivariate model showed that history of surgery (OR = 4.4), the use of HD as the dialysis modality (OR = 3.5), and prolonged time under dialysis (OR = 1.01) were all significantly associated with the presence of hepatitis.
Our results show that the prevalence of hepatitis C is lower in our patients that the prevalence reported by many others (average of other countries 18.5%). Since we found a higher prevalence in HD than in CAPD, even with the lower time under dialysis in the HD group, it is possible that our lower overall prevalence is secondary to the fact that CAPD is the most frequent mode of dialysis in our country. We observed the highest prevalence in the PD/HD group, that is probably due to longer exposure to the risk factors. The association with transfusions before 1991 indicates that the infection was acquired in some patients before dialysis was started. Our results showed that the CAPD is the dialysis technique with lower risk of hepatitis C infection.
终末期肾病患者中，接受血液透析（HD）或持续性非卧床腹膜透析（CAPD）等肾脏替代治疗的丙型肝炎患病率高于普通人群。然而，墨西哥透析患者中丙型肝炎的患病率尚不清楚。因此，本研究的主要目的是确定我们透析患者中丙型肝炎的患病率及其相关危险因素。
我们在墨西哥城南部的三个医院中心对透析患者进行了一项横断面比较研究。对每位患者我们评估了：年龄、性别、肾衰竭病因、透析方式和时间、输血和手术史、血清白蛋白、转氨酶、血尿素氮和血清肌酐。通过ELISA II和血液样本中的定性逆转录聚合酶链反应（RT-PCR）评估丙型肝炎的存在。在所有诊断为丙型肝炎的患者中，还对透析液进行了扩增病毒基因组部分的RT-PCR检测。
我们研究了235例透析患者，根据透析方式分为：132例CAPD患者、17例有HD病史的CAPD患者（PD/HD）和86例HD患者。各研究组的透析时间不同：CAPD组为29.6±22.3个月，PD/HD组为39±42.3个月，HD组为14.2±15.6个月（p<0.01）。235例患者中有24例检测到丙型肝炎，总体患病率为10.2%。在透析液中未发现病毒RNA。然而，患病率因透析类型而异。CAPD组为4.5%，HD组为12.7%，PD/HD组为41.1%（p<0.001）。多因素分析表明，丙型肝炎的危险因素为1991年前的输血（优势比=6.4）和肝炎病史（OR=4.3）。由于1991年前接受输血的患者较少，我们构建了另一个排除该变量的模型。这个新的多因素模型表明，手术史（OR=4.4）、使用HD作为透析方式（OR=3.5）和透析时间延长（OR=1.01）均与丙型肝炎的存在显著相关。
我们的结果表明，我们患者中丙型肝炎的患病率低于许多其他研究报告的患病率（其他国家平均为18.5%）。由于我们发现HD组的患病率高于CAPD组，即使HD组的透析时间较短，我们总体患病率较低可能是因为CAPD是我国最常用的透析方式。我们观察到PD/HD组患病率最高，这可能是由于暴露于危险因素的时间更长。与1991年前输血的关联表明，一些患者在开始透析前就已感染。我们的结果表明，CAPD是丙型肝炎感染风险较低的透析技术。
