Schneeberger P M, Keur I, van der Vliet W, van Hoek K, Boswijk H, van Loon A M, van Dijk W C, Kauffmann R H, Quint W, van Doorn L J
Department of Microbiology, Bosch Medicentrum, Den Bosch, The Netherlands.
J Clin Microbiol. 1998 Jun;36(6):1711-5. doi: 10.1128/JCM.36.6.1711-1715.1998.
A national survey of hepatitis C virus (HCV) infections among dialysis patients in The Netherlands was performed. The study involved 2,653 patients (2,108 hemodialysis patients and 545 chronic ambulatory peritoneal dialysis [CAPD] patients) from 39 of the 49 dialysis centers in the country. Patient sera were analyzed by both serological and molecular methods. Screening by a third-generation enzyme immunoassay (EIA) yielded 79 reactive sera. The presence of anti-HCV antibodies was confirmed in 70 patients by a line immunoassay. All seropositive samples were tested by reverse transcriptase PCR, and 57 samples were found to contain HCV RNA. Of the nine EIA-positive and line immunoassay-negative or indeterminate samples, four were HCV RNA positive. All seronegative samples were screened for the presence of HCV RNA in pools of five sera. Of 2,576 antibody-negative samples, 6 contained HCV RNA. All antibody-positive and RNA-positive samples were also tested by a second serological assay. The prevalence of HCV infections among Dutch dialysis patients as determined by serology or the presence of HCV RNA was 3% (80 of 2,653), i.e., 3.5% (73 of 2,108) in patients treated on hemodialysis and 1.3% (7 of 545) in patients on CAPD. Of these 80 HCV-infected dialysis patients, 67 (84%) were HCV RNA positive. Serological screening alone would have diagnosed only 70 infected patients. Therefore, antibody screening combined with detection of HCV RNA should be considered as the "gold standard" for diagnosing HCV infection in dialysis patients. The prevalence of HCV-infected patients in Dutch dialysis centers ranged from 0 to 8%, suggesting the existence of local risk factors for acquiring HCV infection. Genotyping analysis by reverse hybridization line probe assay revealed the presence of genotypes la (23%), 1b (46%), 2 (3%), 2a (13%), 2b (1%), 3a (7%), and 4a (4%). In four (6%) samples multiple genotypes were detected. The genotype distribution of HCV isolates among Dutch dialysis patients was similar to the distribution among nondialysis patients from the Benelux, except for subtype 1a, which was significantly more prevalent among dialysis patients. In only one center, a high prevalence of an uncommon genotype was suggestive of infection from a common source.
在荷兰开展了一项针对透析患者丙型肝炎病毒（HCV）感染情况的全国性调查。该研究纳入了该国49个透析中心中39个中心的2653例患者（2108例血液透析患者和545例慢性非卧床腹膜透析[CAPD]患者）。采用血清学和分子学方法对患者血清进行分析。通过第三代酶免疫测定（EIA）筛查出79份反应性血清。通过线性免疫测定法在70例患者中确认了抗HCV抗体的存在。对所有血清学阳性样本进行逆转录酶聚合酶链反应（RT-PCR）检测，发现57份样本含有HCV RNA。在9份EIA阳性且线性免疫测定阴性或结果不确定的样本中，有4份HCV RNA呈阳性。对所有血清学阴性样本进行5份血清混合检测HCV RNA的存在情况。在2576份抗体阴性样本中，有6份含有HCV RNA。所有抗体阳性和RNA阳性样本也通过第二种血清学检测方法进行检测。通过血清学或HCV RNA的存在情况确定的荷兰透析患者中HCV感染患病率为3%（2653例中的80例），即血液透析患者中为3.5%（2108例中的73例），CAPD患者中为1.3%（545例中的7例）。在这80例HCV感染的透析患者中，67例（84%）HCV RNA呈阳性。仅进行血清学筛查只能诊断出70例感染患者。因此，抗体筛查联合HCV RNA检测应被视为诊断透析患者HCV感染的“金标准”。荷兰透析中心HCV感染患者的患病率在0%至8%之间，这表明存在导致感染HCV的局部危险因素。通过反向杂交线性探针测定法进行基因分型分析显示存在1a型（23%）、1b型（46%）、2型（3%）、2a型（13%）、2b型（1%）、3a型（7%）和4a型（4%）。在4份（6%）样本中检测到多种基因型。荷兰透析患者中HCV分离株的基因型分布与比荷卢经济联盟非透析患者中的分布相似，但1a亚型在透析患者中更为普遍。仅在一个中心，一种罕见基因型的高患病率提示存在共同来源的感染。
