Espinosa Mario, Martn-Malo Alejandro, Ojeda Raquel, Santamara Rafael, Soriano Sagrario, Aguera Marisa, Aljama Pedro
Servicio de Nefrologa, Hospital Universitario Reina Sofia, Cordoba, Spain.
Am J Kidney Dis. 2004 Apr;43(4):685-9. doi: 10.1053/j.ajkd.2003.12.030.
The prevalence of hepatitis C virus (HCV) infection in hemodialysis (HD) patients has decreased significantly in the course of the past decade in most HD units. The objective of this study is to analyze the causes of this reduction and obtain additional information for the near future that could be of use for health services planning.
All patients who underwent HD in the Province of Cordoba, Spain, between January 1992 and December 2002 were studied. We analyzed annual exclusions from the HD program of HCV-positive patients (deaths and kidney transplantations) and inclusions (predialysis patients, patients with chronic graft rejection, and HD patients with acute HCV infection). The trend in the time series of measurements was calculated by means of exponential smoothing with 2 parameters.
In December 1992, the prevalence of antibody to HCV (anti-HCV) was 24% (N = 54), whereas by December 2002, it had decreased to 9.2% (N = 35). Of 657 predialysis patients included in the maintenance HD program, 2.8% (n = 19) were positive for anti-HCV. Annual mean incidence of acute HCV infection was 0.5%, and the median was 0.32%. Mean crude annual mortality rates were 12.2% for anti-HCV-positive patients versus 9.9% for anti-HCV-negative patients. The trend in this time series suggests that by 2006, the prevalence of anti-HCV in HD patients will be approximately 2.5%.
Causes implicated in the reduction in prevalence of HCV infection in HD patients are a greater mortality rate, stabilization of the incidence of acute HCV infection, and a low percentage of HCV infection in predialysis patients. By the end of 2006, the rate of HCV infection in HD patients will be very close to that of the predialysis population.
在过去十年中，大多数血液透析（HD）单位的血液透析患者丙型肝炎病毒（HCV）感染率已显著下降。本研究的目的是分析这种下降的原因，并获取在不久的将来可能对卫生服务规划有用的更多信息。
对1992年1月至2002年12月期间在西班牙科尔多瓦省接受血液透析的所有患者进行了研究。我们分析了HCV阳性患者从血液透析项目中的年度排除情况（死亡和肾移植）以及纳入情况（透析前患者、慢性移植排斥患者和急性HCV感染的血液透析患者）。通过双参数指数平滑法计算测量时间序列的趋势。
1992年12月，HCV抗体（抗-HCV）患病率为24%（N = 54），而到2002年12月，已降至9.2%（N = 35）。在维持性血液透析项目纳入的657例透析前患者中，2.8%（n = 19）抗-HCV呈阳性。急性HCV感染的年平均发病率为0.5%，中位数为0.32%。抗-HCV阳性患者的年平均粗死亡率为12.2%，而抗-HCV阴性患者为9.9%。该时间序列的趋势表明，到2006年，血液透析患者中抗-HCV的患病率将约为2.5%。
血液透析患者HCV感染率下降的原因包括更高的死亡率、急性HCV感染发病率的稳定以及透析前患者中HCV感染的低比例。到2006年底，血液透析患者中的HCV感染率将非常接近透析前人群的感染率。
