[丙型肝炎病毒在血液透析中的医院内传播：监测仪、工作人员，还是两者皆有？]

[Nosocomial transmission of the hepatitis C virus in hemodialysis: monitors, personnel, or both?].

作者信息

Arenas M D, Sánchez-Payá J, Muñoz C, Egea J J, Martín F, Gil M T, Sarró F

机构信息

Sanatorio Perpetuo Socorro, Servicio de Nefrología, Plaza Dr. Gómez Ulla, 15 03013 Alicante.

出版信息

Nefrologia. 2001 Sep-Oct;21(5):476-84.

PMID:11795017

Abstract

BACKGROUND

The Hepatitis C virus (HCV) infection is the most frequent cause of hepatic disease in the dialysis population. Many observations suggest that nosocomial transmission is the principal way of infection.

OBJECTIVE

The aim of this study was to investigate HCV outbreak in a hemodialysis (HD) unit, using epidemiological and molecular methods.

METHODS

50 patients in a HD unit were tested for HCV-RNA by reverse transcription-polymerase chain reaction (PCR), and the hepatitis C genotype determination (reverse hybridization assay). We analyzed the distribution of different genotypes by shifts and dialysis machines and the temporal association in the appearance of the HCV cases.

RESULTS

21 of 50 patients (42%) showed detectable anti-HCV antibodies (HCV-Ab) in serum. The prevalence of HCV RNA positivity was 90.4% (19/21) among these patients. None of the HCV-Ab negative patients detectable HCV virus in thein blood. The PCR genotyping of HCV RNA was performed in 19 patients. It detected the presence of HCV subtype 1b in 10 out of 19 viremic patients (52.6%), HCV-subtype I a in 31.5% of the patients (6/19) and genotype 3 in 15.7% (3/19) of the viremic patients. All patients had been infected by only one genotype. We found epidemiological correlation and temporal association between the genotypes 1b (p < 0.05) and 3 (p < 0.05) with the shifts. The HCV genotype 1a shows statistical association with the machine 1 (p < 0.05) but not temporal association.

CONCLUSIONS

HCV genotype 1b was dominant in our cohort of HCV-infected patients. There was a high level of agreement between the PCR detection of HCV RNA and the detection of antibodies against the HCV genome. Genotyping and epidemiological analysis suggest that horizontal nosocomial patient to patient transmission plays an important role in the epidemiology of HCV in dialysis patients. There is a need for stringent implementation and regular auditi of infection control measures.

摘要

背景

丙型肝炎病毒（HCV）感染是透析人群肝病最常见的病因。许多观察结果表明，医院内传播是主要的感染途径。

目的

本研究旨在采用流行病学和分子方法调查一家血液透析（HD）单位的HCV暴发情况。

方法

采用逆转录-聚合酶链反应（PCR）对一家HD单位的50例患者进行HCV-RNA检测，并进行丙型肝炎基因分型测定（反向杂交法）。我们分析了不同基因型在班次和透析机之间的分布以及HCV病例出现的时间关联。

结果

50例患者中有21例（42%）血清中可检测到抗-HCV抗体（HCV-Ab）。这些患者中HCV RNA阳性率为90.4%（19/21）。HCV-Ab阴性患者血液中均未检测到HCV病毒。对19例患者进行了HCV RNA的PCR基因分型。在19例病毒血症患者中，检测到10例（52.6%）存在HCV 1b亚型，31.5%的患者（6/19）为HCV-Ia亚型，15.7%（3/19）的病毒血症患者为3型基因型。所有患者仅感染一种基因型。我们发现1b型（p<0.05）和3型（p<0.05）基因型与班次之间存在流行病学相关性和时间关联。HCV 1a基因型与1号机器有统计学关联（p<0.05），但与时间无关。