Schneck H J, Dobler G, Hundelshausen B, Nathrath M, Drescher M
Institut für Anaesthesiologie, Technischen Universität München.
Infusionstherapie. 1991 Oct;18(5):248-55.
302 out of 712 (42%) consecutive polytraumatized ICU patients received ten or more units of stored blood during primary and/or intensive care (1982 to 1987) treatment. 120 of the 197 surviving patients with an average number of transfusions of 23 (10 to 89) units were followed up after a mean interval of 70 (20 to 104) months. Mean duration of continuous post-ICU hospital stay was 17 (2 to 160) weeks, mean number of additional operative procedures was three (0 to 23). Manifest hepatitis had not occurred, all samples were negative for HIV testing. In nine samples (7.5%), anti-HBc-antibodies were positive, while HBs-antigen was negative. Ten patients (8.3%) tested positive for anti-HCV-antibodies (one combined with positive anti-HBc). The rate of serologically positive samples increased with the number of blood units given, duration of overall hospital stay and/or number of secondary surgery; all these findings failed to prove statistically significant. The rate of seropositivity for anti-HBc-antibodies corresponded well with the rate found in voluntary donors in FRG. Manifest or chronic hepatitis B was not observed. As to hepatitis C, the incidence of seropositivity for anti-HCV was found tenfold higher than in healthy blood donors in FRG. The relevance of this result remains unclear, but might indicate chronic post-transfusional hepatitis with high risk of cirrhosis. Among the patients testing positive for anti-HCV, too, acute manifest hepatitis had not occurred. Recently developed RIBA kits might improve specificity and sensitivity of anti-HCV testing. Thus, the frequency of PTH-C could decrease considerably.
在1982年至1987年期间，712例连续性多发伤重症监护病房（ICU）患者中有302例（42%）在初期和/或重症监护治疗期间接受了10单位及以上的库存血。197例存活患者中，有120例平均输血23单位（10至89单位），在平均间隔70个月（20至104个月）后进行了随访。ICU后持续住院的平均时间为17周（2至160周），额外手术操作的平均次数为3次（0至23次）。未发生明显肝炎，所有样本的HIV检测均为阴性。9份样本（7.5%）抗-HBc抗体呈阳性，而HBs抗原呈阴性。10例患者（8.3%）抗-HCV抗体检测呈阳性（1例同时抗-HBc阳性）。血清学阳性样本的比例随输血单位数量、总住院时间和/或二次手术次数的增加而升高；所有这些结果均未显示出统计学显著性。抗-HBc抗体的血清阳性率与联邦德国志愿献血者中的发现相当。未观察到明显或慢性乙型肝炎。至于丙型肝炎，抗-HCV血清阳性的发生率比联邦德国健康献血者高10倍。这一结果的相关性尚不清楚，但可能表明存在慢性输血后肝炎，肝硬化风险较高。在抗-HCV检测呈阳性的患者中，也未发生急性明显肝炎。最近开发的重组免疫印迹分析（RIBA）试剂盒可能会提高抗-HCV检测的特异性和敏感性。因此，输血后肝炎-C（PTH-C）的发生率可能会大幅下降。
