血液透析患者中的丙型肝炎：注射毒品的影响。

Hepatitis C in hemodialysis: the contribution of injection drug use.

机构信息

Hospital Mãe de Deus, Porto Alegre, RS, Brazil.

出版信息

Braz J Infect Dis. 2010 Jul-Aug;14(4):422-6.

PMID:20963332

Abstract

BACKGROUND

Hepatitis C virus (HCV) infection is the most common cause of acute or chronic hepatitis in patients on hemodialysis (HD). The purpose of this study was to describe the prevalence of positive HCV RNA and investigate injection drug use as an emerging risk factor in patients with chronic renal disease on HD.

METHODS

This was a multicenter cross-sectional study with 325 patients with chronic renal disease on HD in the period between August 1, 2005 to August 30, 2006, receiving care at four institutions in the city of Porto Alegre, Southern Brazil. Epidemiological data were collected by means of a structured questionnaire. The following laboratory tests were performed: alanine aminotransferase (ALT), anti-hepatitis C virus antibodies (anti-HCV), and qualitative polymerase chain reaction (PCR).

RESULTS

Of 325 patients, 68 had positive HCV RNA results. The comparison between patients with positive and negative PCR results revealed significant differences in duration of HD (mean = 71 versus 52.4 months; p = 0.02); previous blood transfusion (92% versus 72%; p < 0.01); injection drug use (13% versus 0.7%; p < 0.01); anti-HCV positivity at start of HD therapy (60% versus 4%; p < 0.01); and mean ALT value (39 versus 26.5; p < 0.01). Logistic regression analysis showed a positive HCV RNA independently associated to being on HD for more than five years [OR: 2.1 (95% CI 1.2 -3.8)]; previous blood transfusion [OR: 3.7 (95% CI 1.4 - 9.5)]; and injection drug use [OR: 22.6 (95% CI 4.2 - 119.6)].

CONCLUSION

Injection drug use was an independent risk factor for HCV infection among chronic renal disease patients on HD.

摘要

背景

丙型肝炎病毒（HCV）感染是血液透析（HD）患者急性或慢性肝炎的最常见原因。本研究旨在描述 HCV RNA 阳性的流行率，并研究注射毒品使用作为 HD 慢性肾病患者的新兴危险因素。

方法

这是一项多中心横断面研究，纳入了 2005 年 8 月 1 日至 2006 年 8 月 30 日期间在巴西南里奥格兰德州阿雷格里港的四家机构接受治疗的 325 例慢性肾病 HD 患者。通过结构化问卷收集流行病学数据。进行了以下实验室检查：丙氨酸转氨酶（ALT）、抗丙型肝炎病毒抗体（抗-HCV）和定性聚合酶链反应（PCR）。

结果

在 325 例患者中，有 68 例 HCV RNA 结果阳性。PCR 结果阳性和阴性患者之间的比较显示出以下方面的显著差异：HD 持续时间（平均值=71 与 52.4 个月；p=0.02）；既往输血（92%与 72%；p<0.01）；注射毒品使用（13%与 0.7%；p<0.01）；HD 治疗开始时的抗-HCV 阳性（60%与 4%；p<0.01）；以及平均 ALT 值（39 与 26.5；p<0.01）。逻辑回归分析显示，HCV RNA 阳性与 HD 时间超过五年[比值比（OR）：2.1（95%可信区间 1.2-3.8）]、既往输血[OR：3.7（95%可信区间 1.4-9.5）]和注射毒品使用[OR：22.6（95%可信区间 4.2-119.6）]独立相关。