Iwasa Yuko, Otsubo Shigeru, Sugi Orie, Sato Keitaro, Asamiya Yukari, Eguchi Aya, Iwasaki Tomihito, Matsuda Nami, Kikuchi Kan, Ikebe Norisato, Miwa Naoko, Kimata Naoki, Uchida Keiko, Uchida Shigeharu, Nitta Kosaku, Akiba Takashi
Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Clin Exp Nephrol. 2008 Feb;12(1):53-7. doi: 10.1007/s10157-007-0005-6. Epub 2008 Jan 5.
Although hepatitis C virus (HCV) infection is a persistent public health concern in hemodialysis patients, there seem to have been only a few reports on the prevalence of HCV at the start of hemodialysis. In this study we investigated whether patients starting on hemodialysis therapy are positive for anti-HCV antibody or not.
The 400 patients who began regular hemodialysis between February 2003 and June 2007 were enrolled in this study. Clinical data such as age, anti-HCV antibody and primary cause of end-stage kidney disease (ESKD) were examined. As healthy controls we used 70,717 healthy blood donors in 2005 whose data were obtained from Tokyo Metropolitan Red Cross Blood Center. Anti-HCV antibody was used as an indicator of HCV infection. Since the prevalence of HCV infection is affected by age in Japan, we classified the patients by age group.
The anti-HCV antibody prevalence rate among the patients who were new to hemodialysis was 7.3%, as opposed to 0.15% in the healthy volunteers. The prevalence of HCV in the 31-45-, 46-60-, and 61-year-old groups was significantly higher among the hemodialysis patients than among the healthy volunteers (P = 0.0209, <0.0001, and <0.0001, respectively). The prevalence rate of anti-HCV antibody was higher among men (10.0%) than among women (1.5%, P < 0.0001) in the hemodialysis patients. The anti-HCV-antibody-positive patients were significantly older than the anti-HCV-antibody-negative patients (66.4 +/- 14.3 years versus 58.6+/-16.6 years; P = 0.0152). Diabetic nephropathy was a more frequent cause of ESKD among the anti-HCV-antibody-positive patients (30.4%) than among the anti-HCV-antibody-negative patients (19.9%, P = 0.0122). Among the anti-HCV-antibody-positive patients, 55.2% had received a blood transfusion. The rate was significantly higher than that among the anti-HCV-antibody-negative patients (19.4%, P < 0.0001).
The results showed a much higher rate of anti-HCV antibody positivity in patients new to hemodialysis than in healthy volunteers. Older age, blood transfusion, male gender, and diabetic nephropathy seemed to be risk factors for anti-HCV antibody positivity in Japan.
尽管丙型肝炎病毒（HCV）感染仍是血液透析患者持续关注的公共卫生问题，但关于血液透析开始时HCV患病率的报道似乎较少。在本研究中，我们调查了开始接受血液透析治疗的患者抗-HCV抗体是否呈阳性。
本研究纳入了2003年2月至2007年6月期间开始定期血液透析的400例患者。检查了年龄、抗-HCV抗体和终末期肾病（ESKD）的主要病因等临床数据。作为健康对照，我们使用了2005年东京都红十字血液中心的70717名健康献血者的数据。抗-HCV抗体用作HCV感染的指标。由于在日本HCV感染的患病率受年龄影响，我们按年龄组对患者进行了分类。
新开始血液透析的患者中抗-HCV抗体患病率为7.3%，而健康志愿者中为0.15%。血液透析患者中31 - 45岁、46 - 60岁和61岁以上组的HCV患病率显著高于健康志愿者（分别为P = 0.0209、<0.0001和<0.0001）。血液透析患者中男性抗-HCV抗体患病率（10.0%）高于女性（1.5%，P < 0.0001）。抗-HCV抗体阳性患者明显比抗-HCV抗体阴性患者年龄大（66.4±14.3岁对58.6±16.6岁；P = 0.0152）。在抗-HCV抗体阳性患者中，糖尿病肾病作为ESKD的病因比抗-HCV抗体阴性患者更常见（30.4%对19.9%，P = 0.0122）。在抗-HCV抗体阳性患者中，55.2%接受过输血。该比例显著高于抗-HCV抗体阴性患者（19.4%，P < 0.0001）。
结果显示，新开始血液透析的患者抗-HCV抗体阳性率远高于健康志愿者。在日本，年龄较大、输血、男性性别和糖尿病肾病似乎是抗-HCV抗体阳性的危险因素。
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