Donahue J G, Muñoz A, Ness P M, Brown D E, Yawn D H, McAllister H A, Reitz B A, Nelson K E
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
N Engl J Med. 1992 Aug 6;327(6):369-73. doi: 10.1056/NEJM199208063270601.
The most common serious complication of blood transfusion is post-transfusion hepatitis from the hepatitis C virus (HCV). Blood banks now screen blood donors for surrogate markers of non-A, non-B hepatitis and antibodies to HCV, but the current risk of post-transfusion hepatitis C is unknown.
From 1985 through 1991, blood samples and medical information were obtained prospectively from patients before and at least six months after cardiac surgery. The stored serum samples were tested for antibodies to HCV by enzyme immunoassay, and by recombinant immunoblotting if positive.
Of the 912 patients who received transfusions before donors were screened for surrogate markers, 35 seroconverted to HCV, for a risk of 3.84 percent per patient (0.45 percent per unit transfused). For the 976 patients who received transfusions after October 1986 with blood screened for surrogate markers, the risk of seroconversion was 1.54 percent per patient (0.19 percent per unit). For the 522 patients receiving transfusions since the addition in May 1990 of screening for antibodies to HCV, the risk was 0.57 percent per patient (0.03 percent per unit). The trend toward decreasing risk with increasingly stringent screening of donors was statistically significant (P less than 0.001). After we controlled for the method of donor screening, the risk of seroconversion was strongly associated (P less than 0.001) with the volume of blood transfused, but not with the use of particular blood components.
The incidence of post-transfusion hepatitis C has decreased markedly since the implementation of donor screening for surrogate markers and antibodies to HCV. The current risk of post-transfusion hepatitis is about 3 per 10,000 units transfused.
输血最常见的严重并发症是丙型肝炎病毒（HCV）引起的输血后肝炎。血库现在对献血者进行非甲非乙型肝炎替代标志物和抗HCV抗体筛查，但目前输血后丙型肝炎的风险尚不清楚。
从1985年至1991年，前瞻性地获取心脏手术患者术前及术后至少6个月的血样和医疗信息。储存的血清样本通过酶免疫测定法检测抗HCV抗体，若为阳性则通过重组免疫印迹法检测。
在对献血者进行替代标志物筛查之前接受输血的912例患者中，35例抗HCV血清学转换，每位患者的风险为3.84%（每输注一个单位血液的风险为0.45%）。对于1986年10月以后接受筛查替代标志物血液输血的976例患者，血清学转换风险为每位患者1.54%（每单位0.19%）。对于自1990年5月增加抗HCV抗体筛查后接受输血的522例患者，风险为每位患者0.57%（每单位0.03%）。随着对献血者筛查越来越严格，风险降低的趋势具有统计学意义（P<0.001）。在我们控制了献血者筛查方法后，血清学转换风险与输血量密切相关（P<0.001），但与特定血液成分的使用无关。
自实施献血者替代标志物和抗HCV抗体筛查以来，输血后丙型肝炎的发病率显著下降。目前输血后肝炎的风险约为每输注10000个单位3例。
