Noiri E, Nakao A, Oya A, Fujita T, Kimura S
Departments of Nephrology and Endocrinology and Infectious Disease and Hemodiafiltration Unit, University of Tokyo, Japan.
Am J Kidney Dis. 2001 Jan;37(1):38-42. doi: 10.1053/ajkd.2001.20630.
The prevalence of hepatitis C virus (HCV) positivity among hemodialysis patients remains high compared with that of the healthy population, and thus the issue of safety and environmental protection must be addressed. The purpose of this study is to evaluate the dynamics of prehemodialysis and posthemodialysis blood HCV levels and HCV escape to spent dialysate. Because heparin has an inhibitory effect on the reverse-transcription polymerase chain reaction (RT-PCR) assay, a serine protease inhibitor (nafamostat mesilate) was used as the anticoagulant for hemodialysis. High-flux polysulfone membrane dialyzers were used; dialyzer reuse was not performed. Multicyclic RT-PCR was performed for the quantitative detection of HCV. To elucidate HCV escape to spent dialysate, a portion of total spent dialysate was continuously extracted in a sterile fashion using a minutely adjusted syringe pump. No HCV extravasation to spent dialysate was found, although HCV copy numbers were reduced to a statistically significant level in postdialysis blood compared with predialysis levels (P: < 0.05; n = 20). The need to establish standards for risk management in dialysis centers is evident. The data obtained in this study strongly suggest that to minimize the risk for HCV transmission, lower transmembrane pressure (TMP) should be used in the hemodialysis of HCV-positive patients, with fresh polysulfone dialyzers and dialysis settings of 180 to 250 mL/min for blood flow, 500 mL/min for dialysate flow, and less than 18.72 mm Hg for TMP.
与健康人群相比，血液透析患者中丙型肝炎病毒（HCV）阳性的患病率仍然很高，因此必须解决安全和环境保护问题。本研究的目的是评估血液透析前和透析后血液中HCV水平的动态变化以及HCV向废透析液中的逸出情况。由于肝素对逆转录聚合酶链反应（RT-PCR）检测有抑制作用，因此使用丝氨酸蛋白酶抑制剂（甲磺酸萘莫司他）作为血液透析的抗凝剂。使用高通量聚砜膜透析器；未进行透析器复用。采用多循环RT-PCR对HCV进行定量检测。为了阐明HCV向废透析液中的逸出情况，使用微调注射泵以无菌方式连续抽取一部分总废透析液。尽管与透析前水平相比，透析后血液中的HCV拷贝数降至统计学显著水平（P：<0.05；n = 20），但未发现HCV渗入废透析液。显然需要在透析中心制定风险管理标准。本研究获得的数据强烈表明，为了将HCV传播风险降至最低，HCV阳性患者进行血液透析时应使用较低的跨膜压（TMP），采用新鲜的聚砜透析器，血液流速为180至250 mL/分钟，透析液流速为500 mL/分钟，TMP小于18.72 mmHg。
