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参加日本一项教育项目的慢性肾脏病患者中的乙型肝炎病毒感染

Hepatitis B Virus Infection Among Patients With Chronic Kidney Disease Who Attended an Educational Program in Japan.

作者信息

Tanaka Akihito, Inaguma Daijo, Watanabe Yu, Mizukawa Takahiro, Shinjo Hibiki, Koike Kiyomi, Otsuka Yasuhiro, Takeda Asami

机构信息

Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.

Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.

出版信息

Ther Apher Dial. 2018 Dec;22(6):588-593. doi: 10.1111/1744-9987.12708. Epub 2018 Jul 15.

Abstract

The rate of hepatitis B infection among hemodialysis patients is high. However, it is not clear if this rate reflects the infection rate among patients with chronic kidney disease (CKD). Therefore, we evaluated the rate of hepatitis B infection among patients with CKD. This is an important clinical issue when considering the risk of infection to medical staff when performing invasive procedures in this clinical population. A retrospective, observational study was conducted among stable, non-dialysis patients with CKD who attended a CKD educational program at our hospital, between August 2012 and October 2017. We collected patients' background and markers of hepatitis infection (HBsAg, HBcAb and HBsAb, as well as HBV-DNA when available) from medical records. The data from 496 patients (373 men and 123 women, with a mean age of 69.3 ± 13.0 years and mean level of creatinine of 3.15 ± 1.72 mg/dL, AST of 21.6 ± 10.5 IU/L, and ALT of 17.3 ± 12.5 IU/L), were included in the analysis. The rate of positive testing for hepatitis B virus infection was as follows: HBsAg, 1.6%; HBsAb, 16.5%; and HBcAb, 21.4%. Of the patients with a negative HBsAg test, 20.1% tested positive for HBcAb. Of the 66 patients in whom HBV-DNA testing was performed, 10.6% tested positive. The rate of hepatitis B virus infection was specifically higher among patients ≥71-years-old. In patients with CKD, the rate of HBsAg positivity is high. Rate of HBcAb positivity is higher particularly in older individuals.

摘要

血液透析患者中乙型肝炎感染率很高。然而,尚不清楚该感染率是否反映了慢性肾脏病(CKD)患者中的感染率。因此,我们评估了CKD患者中的乙型肝炎感染率。在考虑对这一临床人群进行侵入性操作时医护人员的感染风险时,这是一个重要的临床问题。2012年8月至2017年10月期间,对我院参加CKD教育项目的病情稳定的非透析CKD患者进行了一项回顾性观察研究。我们从病历中收集了患者的背景信息和肝炎感染标志物(HBsAg、HBcAb和HBsAb,如有可用的HBV-DNA也一并收集)。分析纳入了496例患者(373例男性和123例女性,平均年龄69.3±13.0岁,肌酐平均水平3.15±1.72mg/dL,AST为21.6±10.5IU/L,ALT为17.3±12.5IU/L)。乙型肝炎病毒感染检测阳性率如下:HBsAg为1.6%;HBsAb为16.5%;HBcAb为21.4%。HBsAg检测阴性的患者中,20.1%的HBcAb检测呈阳性。在进行HBV-DNA检测的66例患者中,10.6%检测呈阳性。71岁及以上患者的乙型肝炎病毒感染率尤其高。在CKD患者中,HBsAg阳性率很高。HBcAb阳性率尤其在老年个体中更高。

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