Yang Chwei-Shiun, Chang Hsu-Hung, Chou Chia-Chi, Peng Sheng-Jeng
Division of Nephrology, Department of Internal Medicine, Cathay General Hospital, Taipei Medical University, 280 Jen-Ai Road, Section 4, Taipei, Taiwan.
J Formos Med Assoc. 2003 Feb;102(2):79-85.
Many preventative strategies have been proposed to control hepatitis C virus (HCV) infection in the hemodialysis unit. The effectiveness of isolation as a preventive policy remains unclear. The aim of this study was to evaluate the effect of an isolation policy on the incidence of hepatitis C in our hemodialysis unit.
A total of 325 hemodialysis patients with a mean age of 62 +/- 14 years and a mean duration of dialysis of 4.8 +/- 4.4 years, who were treated from January 1993 to December 2000 were included in this retrospective study. Data were collected from medical records. HCV antibody was monitored at 6-month intervals. During the period before September 1997 all patients were dialyzed in a single room. Isolation started after September 1997, when an additional room became available. Patients positive for either hepatitis B or C were clustered in 1 area (Area 1). Anti-HCV-negative and hepatitis B surface antigen (HBsAg)-negative patients were assigned either to a segregated zone (Area 2) adjacent to Area 1 in the same room or to a separate independent room (Area 3). Dialyzers were not reused and hygienic precautions remained the same throughout the study period.
Forty months after the implementation of the isolation policy, there was significant reduction in the total prevalence (49.7 vs 31.7%, p < 0.01) and incidence (9.1 vs 2.9 % patient-years, p < 0.01) of HCV infection. Seroconversion of anti-HCV was detected in 9 patients, 7 in Area 1, 2 in Area 2, with no new cases in Area 3. The incidence of seroconversion of anti-HCV was significantly different in the 3 areas. Regression analysis indicated that isolation was the most prominent independent factor in reducing seroconversion of anti-HCV.
These results support the use of an isolation policy to combat HCV infection among hemodialysis patients, particularly in high prevalence units.
已提出多种预防策略来控制血液透析单位中的丙型肝炎病毒（HCV）感染。隔离作为一种预防措施的有效性仍不明确。本研究的目的是评估隔离政策对我们血液透析单位丙型肝炎发病率的影响。
本回顾性研究纳入了1993年1月至2000年12月期间接受治疗的325例血液透析患者，平均年龄62±14岁，平均透析时间4.8±4.4年。数据从病历中收集。每6个月监测一次HCV抗体。1997年9月之前，所有患者均在单人房间进行透析。1997年9月后有了额外的房间，开始实行隔离。乙肝或丙肝阳性的患者集中在一个区域（区域1）。抗HCV阴性且乙肝表面抗原（HBsAg）阴性的患者被分配到与区域1相邻的同一房间的隔离区（区域2）或单独的独立房间（区域3）。透析器不重复使用，整个研究期间卫生预防措施保持不变。
实施隔离政策40个月后，HCV感染的总患病率（49.7%对31.7%，p<0.01）和发病率（9.1%对2.9%患者年，p<0.01）显著降低。在9例患者中检测到抗HCV血清转化，区域1有7例，区域2有2例，区域3无新病例。抗HCV血清转化的发生率在3个区域有显著差异。回归分析表明，隔离是降低抗HCV血清转化的最主要独立因素。
这些结果支持采用隔离政策来对抗血液透析患者中的HCV感染，特别是在高流行率单位。
