El-Sherif Assem, Elbahrawy Ashraf, Aboelfotoh Atef, Abdelkarim Magdy, Saied Mohammad Abdel-Gawad, Abdallah Abdallah Mahmoud, Mostafa Sadek, Elmestikawy Amr, Elwassief Ahmed, Salah Mohamed, Abdelbaseer Mohamed Ali, Abdelwahab Kouka Saadeldin
Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
Hemodial Int. 2012 Jul;16(3):420-7. doi: 10.1111/j.1542-4758.2011.00662.x. Epub 2012 Feb 23.
Routine serological testing for hepatitis C virus (HCV) infection among hemodialysis (HD) patients is currently recommended. A dilemma existed on the value of serology because some investigators reported a high rate of false-negative serologic testing. In this study, we aimed to detect the false-negative rate of anti-HCV among Egyptian HD patients. Seventy-eight HD patients, negative for anti-HCV, anti-HIV, and hepatitis B surface antigen, were tested for HCV RNA by reverse transcriptase polymerase chain reaction (RT-PCR). In the next step, the viral load was quantified by real-time PCR in RT-PCR-positive patients. Risk factors for HCV infection, as well as clinical and biochemical indicators of liver disease, were compared between false-negative and true-negative anti-HCV HD patients. The frequency of false-negative anti-HCV was 17.9%. Frequency of blood transfusion, duration of HD, dialysis at multiple centers, and diabetes mellitus were not identified as risk factors for HCV infection. The frequency of false-negative results had a linear relation to the prevalence of HCV infection in the HD units. Timely identification of HCV within dialysis units is needed in order to lower the risk of HCV spread within the HD units. The high false-negative rate of anti-HCV among HD patients in our study justifies testing of a large scale of patients for precious assessment of effectiveness of nucleic acid amplification technology testing in screening HD patient.
目前建议对血液透析（HD）患者进行丙型肝炎病毒（HCV）感染的常规血清学检测。血清学检测的价值存在争议，因为一些研究者报告血清学检测的假阴性率很高。在本研究中，我们旨在检测埃及HD患者中抗HCV的假阴性率。对78例抗HCV、抗HIV和乙肝表面抗原均为阴性的HD患者进行逆转录聚合酶链反应（RT-PCR）检测HCV RNA。下一步，对RT-PCR阳性患者通过实时PCR对病毒载量进行定量。比较抗HCV假阴性和真阴性HD患者的HCV感染危险因素以及肝病的临床和生化指标。抗HCV假阴性率为17.9%。输血频率、HD持续时间、多中心透析和糖尿病未被确定为HCV感染的危险因素。假阴性结果的频率与HD单位中HCV感染的患病率呈线性关系。为降低HCV在HD单位内传播的风险，需要在透析单位及时识别HCV。我们研究中HD患者抗HCV的高假阴性率证明对大量患者进行检测对于准确评估核酸扩增技术检测在筛查HD患者中的有效性是合理的。
