[血液透析患者丙型肝炎病毒感染：患病率及危险因素]

[Infection by hepatitis C virus in patients on hemodialysis: prevalence and risk factors].

作者信息

Leão José Rafael, Pace Fabio Heleno de Lima, Chebli Julio Maria Fonseca

机构信息

Programa de Pós-Graduação em Ciências da Saúde, Núcleo de Pesquisa em Gastroenterologia, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG.

出版信息

Arq Gastroenterol. 2010 Jan-Mar;47(1):28-34. doi: 10.1590/s0004-28032010000100006.

DOI:10.1590/s0004-28032010000100006

PMID:20520972

Abstract

CONTEXT

Chronic renal disease patients on hemodialysis are at increased risk of infection by hepatitis C virus (HCV). High prevalence rates have been reported from dialysis units worldwide. Recent studies have shown an inverse relation between HCV infection and life expectancy of patients on hemodialysis and those undergoing renal transplant.

OBJECTIVES

Assess the prevalence of and risk factors for HCV infection in patients undergoing hemodialysis.

METHODS

A cross-sectional study was undertaken from January to December, 2007. During this period, 236 patients were tested for anti-HCV antibodies with third generation ELISA. Those who tested positive further underwent qualitative PCR testing for HCV-RNA. A subject was considered HCV-infected if both tests (anti-HCV and HCV-RNA) were positive. Monthly serum ALT and the mean for the 12-month period were obtained from 195 patients. Two hundred eight (88.1%) patients answered a standardized questionnaire aiming to identify risk factors for HCV infection.

RESULTS

Of the 236 subjects studied, 14.8% (35/236) tested positive for anti-HCV antibodies. Of these, 71.6% (25/35) tested positive for HCV-RNA. Chronic HCV infection was thus prevalent in 10.6% (25/236). Bivariate analysis showed time on hemodialysis, number of blood transfusions, previous peritoneal dialysis and previous sexually transmitted diseases to be the main risk factors for HCV infection. Yet multivariate analysis showed that just time on hemodialysis and previous sexually transmitted diseases were significantly associated with HCV infection. Patients on hemodialysis for over 10 years were 73.9 (CI 17.5-311.8) times as likely to have acquired HCV, compared with those on hemodialysis for up to 5 years. Patients with previous sexually transmitted diseases had a 4.8 times higher risk of HCV infection compared with those without previous sexually transmitted diseases. Mean serum ALT was significantly higher in HCV-infected patients (44.0 +/-13.5 U/L versus 33.5 +/- 8.0 U/L, P<0,001).

CONCLUSION

HCV infection was highly prevalent in the dialysis unit studied. Time on dyalitic treatment and previous sexually transmitted diseases were the main risk factors for HCV infection. HCV-infected patients on hemodialysis had higher serum ALT levels than those without chronic HCV infection.

摘要

背景

接受血液透析的慢性肾病患者感染丙型肝炎病毒（HCV）的风险增加。世界各地的透析单位报告了较高的患病率。最近的研究表明，HCV感染与接受血液透析和肾移植患者的预期寿命呈负相关。

目的

评估接受血液透析患者HCV感染的患病率及危险因素。

方法

于2007年1月至12月进行了一项横断面研究。在此期间，采用第三代酶联免疫吸附试验（ELISA）对236例患者进行抗HCV抗体检测。检测呈阳性者进一步接受HCV-RNA定性聚合酶链反应（PCR）检测。如果抗HCV和HCV-RNA两项检测均为阳性，则该受试者被视为HCV感染者。从195例患者中获取每月血清丙氨酸氨基转移酶（ALT）及12个月期间的平均值。208例（88.1%）患者回答了一份标准化问卷，旨在确定HCV感染的危险因素。

结果

在研究的236例受试者中，14.8%（35/236）抗HCV抗体检测呈阳性。其中，71.6%（25/35）HCV-RNA检测呈阳性。因此，慢性HCV感染在10.6%（25/236）的患者中流行。双变量分析显示，血液透析时间、输血次数、既往腹膜透析史和既往性传播疾病史是HCV感染的主要危险因素。然而，多变量分析显示，只有血液透析时间和既往性传播疾病史与HCV感染显著相关。与血液透析时间长达5年的患者相比，血液透析超过10年的患者感染HCV的可能性高73.9（95%可信区间17.5-311.8）倍。有既往性传播疾病史的患者感染HCV的风险比无既往性传播疾病史的患者高4.8倍。HCV感染患者的血清ALT平均值显著更高（44.0±13.5 U/L对33.5±8.0 U/L，P<0.001）。