Agarwal S K, Dash S C, Irshad M
Dept of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India.
J Assoc Physicians India. 1999 Dec;47(12):1139-43.
Hepatitis C viral (HCV) infection is a major cause of hepatitis during haemodialysis after the control of hepatitis B following vaccination and isolation measures. Magnitude of this problem in India has not been studied and there are only few reports of HCV infection during haemodialysis from this country. This study was conducted to find out the incidence of HCV infection in patients of end stage renal disease (ESRD) and haemodialysis (HD), along with its source and to find out the clinical course of HCV positive patients.
HCV infection was diagnosed by detecting anti-HCV antibodies using the IIIrd generation ELISA kits.
Of the 208 consecutive patients of ESRD accepted for the study, HCV prevalence was 4.3% at the time of start of study. Of the all risk factors studied, past history of jaundice and number of blood transfusion (BT) were significantly higher in HCV positive patients as compared to HCV negative patients. Of the 208 patients, 20 (9.6%) died, 119 (57.2%) lost follow-up and 69 (33.2%) got renal transplant (RT). Incidence of HCV in patients who died, lost follow-up and got RT was 10%, 3.4% and 36.2% while prevalence was 15%, 4.2% and 42% respectively. In these groups, duration of HD was 8.4, 5.2 and 22.7 weeks respectively while the mean blood transfusion (BT) was 1.2, 0.8 and 5.4 in number respectively. Mean age of patients in these groups was 37.85, 37.9 and 32.53 years and percentage of males were 65%, 75% and 89.9% respectively. At no stage of follow-up, patients with HCV infection had any symptoms or high serum bilirubin. Major abnormality was fluctuating ALT in these patients. HCV in 512 units of blood transfusions given to these patients and healthy volunteers was 1.17% and 0.66% respectively. Marked increase of HCV infection while patients were on HD is likely to be due to nosocomial spread. Blood transfusion was not found to be important source of HCV infection. Longer the patients remain on HD; more will be chance of HCV infection.
It is concluded that HCV is a major cause of concern in haemodialysis patients in India and the predominant source of spread of infection is nosocomial. In our set-up, blood transfusion is not an important source of infection. Majority of these patients remains asymptomatic at least for the short terms follow-up.
在通过疫苗接种和隔离措施控制乙型肝炎后，丙型肝炎病毒（HCV）感染是血液透析期间肝炎的主要原因。印度这一问题的严重程度尚未得到研究，该国仅有少数关于血液透析期间HCV感染的报告。本研究旨在确定终末期肾病（ESRD）和血液透析（HD）患者中HCV感染的发生率、感染源，并了解HCV阳性患者的临床病程。
使用第三代ELISA试剂盒检测抗HCV抗体来诊断HCV感染。
在接受该研究的208例连续ESRD患者中，研究开始时HCV患病率为4.3%。在所有研究的危险因素中，与HCV阴性患者相比，HCV阳性患者的黄疸既往史和输血次数显著更高。208例患者中，20例（9.6%）死亡，119例（57.2%）失访，69例（33.2%）接受了肾移植（RT）。死亡、失访和接受RT患者的HCV发病率分别为10%、3.4%和36.2%，而患病率分别为15%、4.2%和42%。在这些组中，HD持续时间分别为8.4周、5.2周和22.7周，平均输血次数分别为1.2次、0.8次和5.4次。这些组中患者的平均年龄分别为37.85岁、37.9岁和32.53岁，男性比例分别为65%、75%和89.9%。在随访的任何阶段，HCV感染患者均无任何症状或高血清胆红素。这些患者的主要异常是ALT波动。给这些患者和健康志愿者输注的512单位血液中HCV感染率分别为1.17%和0.66%。患者进行HD期间HCV感染显著增加可能是由于医院内传播。未发现输血是HCV感染的重要来源。患者进行HD的时间越长，HCV感染的机会就越大。
得出结论，HCV是印度血液透析患者中一个主要关注的问题，感染传播的主要来源是医院内传播。在我们的研究中，输血不是重要的感染源。这些患者中的大多数至少在短期随访中无症状。
