血液透析患者中庚型肝炎病毒感染的发病率、传播及临床意义。

Huang J J, Lee W C, Ruaan M K, Wang M C, Chang T T, Young K C

Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.

Eur J Clin Microbiol Infect Dis. 2001 Jun;20(6):374-9. doi: 10.1007/s100960100509.

A high prevalence of hepatitis G virus (HGV) infection has been noted in patients receiving chronic hemodialysis (HD) therapy, yet the incidence rate and transmission route have rarely been reported. Serum samples from 160 chronically uremic patients in a HD unit were initially collected at the time chronic HD therapy was begun, and thereafter annually in July and, finally, in November 1999. Serum HGV RNA was detected using nested reverse transcription polymerase chain reaction, and HGV E2 antibody was determined using an enzyme immunoassay. Nucleotide sequences of the 5'-noncoding region were studied in the HD patients with HGV viremia. Forty healthy staff members were also enrolled as control subjects. Three of the 40 (7.5%) healthy staff members were positive for HGV RNA or HGV E2 antibodies, in contrast to 40 of the 160 (25%) HD patients, including 14 (8.8%) who were positive for HGV RNA only, 25 (15.6%) who were positive for HGV E2 antibody only, and 1 (0.6%) who had both markers. HGV exposure did not correlate with gender, age, duration of HD therapy, or history of blood transfusions. At least 20 of the 40 (50%) patients with HGV exposure had been infected before the start of chronic HD therapy. Nevertheless, at least nine (22.5%) patients acquired new HGV infections after starting chronic HD therapy, with an incidence rate of > or = 2.6% per year. Three patients with newly acquired HGV viremia after HD therapy was started and two with pre-existing HGV viremia before HD therapy was started had the same nucleotide sequences. HGV and HCV infections (with a prevalence of 14.4%) might have been transmitted independently in HD patients. In addition, HGV infection was not found to cause significant elevation of alanine aminotransferase levels in the group exposed to HGV. To conclude, the incidence of new HGV infections was at least 2.6% per year. In addition to transmission through blood transfusion, HGV may have been transmitted nosocomially patient-to-patient within the HD unit. The compliance with standard universal precautions should be carefully re-examined, but it is not necessary to routinely screen for HGV infection among patients on chronic HD.

在接受慢性血液透析（HD）治疗的患者中，庚型肝炎病毒（HGV）感染的发生率较高，但关于其发病率和传播途径的报道却很少。在一家血液透析单位，于慢性HD治疗开始时最初采集了160例慢性尿毒症患者的血清样本，此后每年7月采集，最后于1999年11月采集。使用巢式逆转录聚合酶链反应检测血清HGV RNA，并使用酶免疫测定法测定HGV E2抗体。对HGV病毒血症的HD患者的5'-非编码区核苷酸序列进行了研究。还招募了40名健康工作人员作为对照。40名健康工作人员中有3名（7.5%）HGV RNA或HGV E2抗体呈阳性，相比之下，160例HD患者中有40例（25%）呈阳性，其中仅HGV RNA阳性的有14例（8.8%），仅HGV E2抗体阳性的有25例（15.6%），两种标志物均阳性的有1例（0.6%）。HGV暴露与性别、年龄、HD治疗持续时间或输血史无关。40例HGV暴露患者中至少有20例（50%）在慢性HD治疗开始前就已感染。然而，至少有9例（22.5%）患者在开始慢性HD治疗后感染了新的HGV，年发病率≥2.6%。3例HD治疗开始后新获得HGV病毒血症的患者和2例HD治疗开始前就已存在HGV病毒血症的患者具有相同的核苷酸序列。HGV和HCV感染（患病率为14.4%）可能在HD患者中独立传播。此外，在HGV暴露组中未发现HGV感染导致丙氨酸转氨酶水平显著升高。总之，新HGV感染的年发病率至少为2.6%。除了通过输血传播外，HGV可能在HD单位内通过患者间的医院内传播。应仔细重新审视对标准通用预防措施的依从性，但在慢性HD患者中无需常规筛查HGV感染。