dos Santos J P, Loureiro A, Cendoroglo Neto M, Pereira B J
New England Medical Center, Boston, MA 02111, USA.
Nephrol Dial Transplant. 1996 Oct;11(10):2017-22. doi: 10.1093/oxfordjournals.ndt.a027090.
Despite the advent of screening of blood products for anti-hepatitis C virus (HCV), the incidence of HCV infection among haemodialysis (HD) patients is alarmingly high and suggest transmission within the HD unit. To analyse trends in the prevalence and incidence of HCV infection, and evaluate the impact of dialysis room and reuse policies on the incidence of HCV infection, a hospital survey instrument was sent out to medical directors of all 71 HD units in Portugal in August 1994. Information for the years 1991, 1992 and 1993 was requested with respect to HCV infection, defined as positive anti-HCV test. Sixty-two of 71 units (87%) treating 4232 patients in 1993 responded. Overall, data from 5774 patient-years were available for analyses. Observations over multiple intervals were pooled into a single sample, and pooled logistic regression was used to evaluate the relationship between risk factors/strategies and incidence of HCV infection. By 1993, regular anti-HCV testing of patients and staff was practised by 98% and 82% of units, respectively. There was a significant decline in the incidence of HCV infection from 9.9% in 1991 to 5.7% in 1992 and 5.1% in 1993. The incidence was directly related to the prevalence in the dialysis unit. Units with a prevalence of less than 19% had an annual incidence of 2.5% compared to a 35.3% incidence in units with a prevalence greater than 60%. There was wide variation in the incidence of HCV infection in HD units across the country, with geographical location, unit ownership and socioeconomic factors playing a significant role. The incidence was lowest among units that: (i) were located in the northern regions of the country; (ii) were private hospital-based units; and (iii) used dedicated machines or separate rooms for anti-HCV-positive patients. The incidence among units that reprocessed dialysers (6.1%) was not significantly different from that among units that did not reprocess dialysers (7.4%). However, among units that did reprocess dialysers, the incidence of HCV infection was lowest in: (i) units that used separate rooms for reprocessing dialysers from anti-HCV-positive patients or did not reprocess these dialysers; and (ii) units that used Renalin as the sterilant. These results suggest the transmission of HCV infection in HD units and that use of dedicated machines and isolation of anti-HCV-positive patients and their dialysers may reduce the incidence of HCV infection.
尽管已开始对血液制品进行抗丙型肝炎病毒（HCV）筛查，但血液透析（HD）患者中HCV感染的发生率仍高得惊人，提示感染在HD治疗单元内传播。为分析HCV感染的患病率和发病率趋势，并评估透析室和复用政策对HCV感染发病率的影响，1994年8月向葡萄牙所有71个HD治疗单元的医疗主任发放了一份医院调查问卷。要求提供1991年、1992年和1993年有关HCV感染的信息，HCV感染定义为抗HCV检测呈阳性。1993年，71个治疗4232例患者的单元中有62个（87%）作出了回应。总体而言，有5774患者年的数据可供分析。将多个时间段的观察结果汇总为一个样本，并采用汇总逻辑回归分析评估危险因素/策略与HCV感染发病率之间的关系。到1993年，分别有98%和82%的单元对患者和工作人员进行定期抗HCV检测。HCV感染的发病率从1991年的9.9%显著下降至1992年的5.7%和1993年的5.1%。发病率与透析单元内的患病率直接相关。患病率低于19%的单元年发病率为2.5%，而患病率高于60%的单元发病率为35.3%。全国HD治疗单元中HCV感染的发病率差异很大，地理位置、单元所属性质和社会经济因素起着重要作用。发病率在以下单元中最低：（i）位于该国北部地区的单元；（ii）以私立医院为基础的单元；（iii）为抗HCV阳性患者使用专用机器或单独房间的单元。对透析器进行复用的单元的发病率（6.1%）与未复用透析器的单元的发病率（7.4%）无显著差异。然而，在对透析器进行复用的单元中，HCV感染的发病率在以下单元中最低：（i）将抗HCV阳性患者的透析器分开房间进行复用或不对这些透析器进行复用的单元；（ii）使用Renalin作为消毒剂的单元。这些结果提示HD治疗单元内存在HCV感染传播，使用专用机器以及隔离抗HCV阳性患者及其透析器可能会降低HCV感染的发病率。
