Bonaguidi-Magniaux M, Pilette C, Oberti F, Bidet M L, Calès P
Centre Départemental de Transfusion Sanguine, CHU, Angers.
Gastroenterol Clin Biol. 1996;20(8-9):663-8.
Our aim was to study the characteristics of blood donors with serum anti-HCV antibodies, their medical follow-up based on a questionnaire, and the follow-up of their recipients who were transfused before systematic screening of anti-HCV antibodies had begun.
From March 1990 to January 1992, 25,255 blood donors were tested by ELISA 1 or ELISA 2 serum tests and confirmed by RIBA 2 test in case of positivity: 126 (0.5%) were ELISA positive of whom 40 (0.16%) were RIBA 2 positive (n = 18) or indeterminate (n = 22); among the latter, 13 were retested by RIBA 3 which was positive in 2 cases. Thus, the prevalence of blood donors with truly positive HCV antibodies testing was shown to be between 0.08 and 0.12%. Among the 126 ELISA positive blood donors, 90 had given blood before systematic screening had begun, involving 232 patients and 50 non nominative products.
In donors with positive ELISA test, the prevalence of serum ALT activity > 2N was 17% if the RIBA test was positive vs 1% if the test was negative or indeterminate (P = 0.0007). The rate of donors with serum ALT activity > N before March 1990 was 62.5% if the RIBA test was positive vs 17.5% if it was negative (P = 0.01). The follow-up at 2 years of 34 out of 40 donors with a positive or indeterminate RIBA test showed that 88% had had at least two serum ALT activity tests, that 12% had had a serologic test, that 6% had sought the advice of a specialist, and that a liver biopsy was performed in 3%. The follow-up of recipients showed that the response rate of physicians or recipients was 37% (47% at public hospital and 12% in private hospital, P < 0.01). The rate of recipients positive for HCV was 25%, that is 2% of the entire group, yielding an estimated 8% efficiency of the survey. Lack of screening was due to the lack of responses from physicians or recipients in 64% of cases and to the death of the recipient in 36% of cases.
HCV seroprevalence among blood donors in France is closed to that observed in Northern Europe. In this population, there is a great discrepancy between the ELISA and RIBA tests. During the survey period, the follow-up of HCV positive blood donors seemed to be very insufficient. The screening of their recipients was poorly effective, thus emphasizing the importance of the systematic and prospective follow-up of blood donors.
我们的目的是研究血清抗丙型肝炎病毒（HCV）抗体阳性献血者的特征，基于问卷调查对他们进行医学随访，并对在抗HCV抗体系统筛查开始之前接受输血的受血者进行随访。
1990年3月至1992年1月，对25255名献血者进行酶联免疫吸附测定（ELISA）1或ELISA 2血清检测，若结果呈阳性则通过重组免疫印迹法（RIBA）2检测进行确认：126人（0.5%）ELISA检测呈阳性，其中40人（0.16%）RIBA 2检测呈阳性（n = 18）或不确定（n = 22）；在后者中，13人通过RIBA 3重新检测，其中2例呈阳性。因此，HCV抗体检测真正呈阳性的献血者患病率显示在0.08%至0.12%之间。在126名ELISA检测呈阳性的献血者中，90人在系统筛查开始之前就已献血，涉及232名患者和50份无记名制品。
在ELISA检测呈阳性的献血者中，若RIBA检测呈阳性，血清丙氨酸氨基转移酶（ALT）活性>2倍正常上限（2N）的患病率为17%，而若检测呈阴性或不确定则为1%（P = 0.0007）。1990年3月之前血清ALT活性>N的献血者比例，若RIBA检测呈阳性为62.5%，若呈阴性则为17.5%（P = 0.01）。对40名RIBA检测呈阳性或不确定的献血者中的34人进行了2年随访，结果显示88%至少进行了两次血清ALT活性检测，12%进行了血清学检测，6%咨询了专家，3%进行了肝活检。对受血者的随访显示，医生或受血者的回复率为37%（公立医院为47%，私立医院为12%，P < 0.01）。HCV呈阳性的受血者比例为25%，即占整个群体的2%，调查估计效率为8%。筛查缺失的原因在64%的病例中是医生或受血者未回复，在36%的病例中是受血者死亡。
法国献血者中HCV血清流行率与北欧观察到的情况相近。在这一人群中，ELISA和RIBA检测之间存在很大差异。在调查期间，对HCV阳性献血者的随访似乎非常不足。对其受血者的筛查效果不佳，从而强调了对献血者进行系统和前瞻性随访的重要性。
