科索沃血液透析患者丙型肝炎病毒感染的高流行率：一项全国性研究。
A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study.
机构信息
Department of Microbiology, Kosovo National Institute of Public Health, Rrethi i Spitalit, p.n, 10000, Prishtina, Kosovo.
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia.
出版信息
BMC Nephrol. 2018 Nov 3;19(1):304. doi: 10.1186/s12882-018-1100-5.
BACKGROUND
Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasionally reported, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries. This study systematically assessed the prevalence of HCV infection among all patients at all hemodialysis centers in Kosovo, determined the HCV genotype distribution, and reviewed the main risk factors associated with HCV infection in this group of patients.
METHODS
From January to March 2013, blood samples from all patients undergoing hemodialysis at all seven hemodialysis centers in Kosovo were collected. The samples were screened for the presence of anti-HCV antibodies, and seropositive samples were also tested for HCV RNA. Genotyping was performed by sequencing the core region of the HCV genome. Subsequently, face-to-face interviews were conducted with consented patients attending hemodialysis in December 2015 and with the management of all hemodialysis centers in Kosovo.
RESULTS
The overall seroprevalence of HCV infection among hemodialysis patients in Kosovo was 53.0% (354/668), ranging from 22.3 to 91.1% at different centers. HCV RNA was detected in 323/354 (91.2%) seropositive patients. The most frequent HCV genotype was genotype 1a (62.2%), followed by genotypes 4d (33.1%), 1b (4.0%), and 2c (0.7%). The duration of hemodialysis and receiving dialysis at more than one center were identified as independent significant predictors of anti-HCV positivity. Shortage of staff, lack of resources, and inconsistent use of hygienic precautions and/or isolation strategies were observed.
CONCLUSIONS
The prevalence of HCV infection among hemodialysis patients in Kosovo is extremely high. The relatively low prevalence of HCV infection in the general population, predominance of two otherwise rare HCV genotypes among hemodialysis patients, and longer history of hemodialysis as a predictor of HCV infection all indicate nosocomial transmission due to inappropriate infection control practices as the main transmission route.
背景
如果在血液透析环境中未采取有效控制丙型肝炎病毒（HCV）感染的措施，接受血液透析的患者感染 HCV 的风险很高。虽然在发达国家偶尔会报告一些血液透析单位中孤立的小规模 HCV 暴发，但在资源匮乏的国家，HCV 在血液透析环境中的传播仍然是一个重大问题。本研究系统评估了科索沃所有血液透析中心所有患者的 HCV 感染流行率，确定了 HCV 基因型分布，并回顾了该组患者中与 HCV 感染相关的主要危险因素。
方法
2013 年 1 月至 3 月，从科索沃所有 7 个血液透析中心接受血液透析的所有患者中采集血样。对这些样本进行抗 HCV 抗体检测，对阳性样本进行 HCV RNA 检测。通过对 HCV 基因组核心区进行测序进行基因分型。随后，于 2015 年 12 月对接受血液透析的同意患者和科索沃所有血液透析中心的管理层进行了面对面访谈。
结果
科索沃血液透析患者的 HCV 总感染血清阳性率为 53.0%（354/668），不同中心的血清阳性率范围为 22.3%至 91.1%。在 354 例血清阳性患者中，有 323 例（91.2%）检测到 HCV RNA。最常见的 HCV 基因型是 1a 型（62.2%），其次是 4d 型（33.1%）、1b 型（4.0%）和 2c 型（0.7%）。血液透析时间和在多个中心接受透析被确定为抗 HCV 阳性的独立显著预测因素。工作人员短缺、资源匮乏以及卫生防护措施和/或隔离策略的使用不一致等问题也很突出。
结论
科索沃血液透析患者的 HCV 感染流行率极高。普通人群中 HCV 感染的相对低流行率、血液透析患者中两种相对罕见的 HCV 基因型占主导地位以及血液透析时间较长作为 HCV 感染的预测因素，均表明由于感染控制措施不当导致的医源性传播是主要传播途径。
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