Mizuno M, Higuchi T, Kanmatsuse K, Esumi M
First Department of Pathology, Nihon University School of Medicine, Tokyo, Japan.
J Clin Microbiol. 1998 Oct;36(10):2926-31. doi: 10.1128/JCM.36.10.2926-2931.1998.
We investigated the unrecognized patient-to-patient transmission of hepatitis C virus (HCV) in hemodialysis units by performing phylogenetic and serological analyses of hypervariable region 1 (HVR1) of HCV. Of the 62 patients in one center, 11 were positive for HCV RNA. A total of 24 HVR1 sequences, including the minor population of sequences of HCV isolates, from each patient were closely related and classified into five clusters by phylogenetic analysis. Of the 11 patients, 5 were infected with multiple clusters of HCV. Two patients were infected with HCV during an 18-month interval between examinations, and these HVR1 sequences fell into one of the five clusters. In another hemodialysis center, 5 of the 20 patients were HCV RNA positive, and two HVR1 sequences were found to be closely related and phylogenetically derived from the same cluster. The antibody responses of these patients to the HVR1 peptides representative of the genetic clusters revealed exactly the same clustering as that shown by phylogenetic analysis. These findings suggest that phylogenetic and serological analyses of HVR1 sensitively detect unrecognized and multiple transmission of HCV occurring within the same room in hemodialysis centers. Fingerprinting analyses using hypervariable regions of infectious agents are useful in identifying the precise route of transmission of infection.
我们通过对丙型肝炎病毒（HCV）高变区1（HVR1）进行系统发育和血清学分析，研究了血液透析单位中未被识别的HCV患者间传播情况。在一个中心的62例患者中，11例HCV RNA呈阳性。通过系统发育分析，从每位患者中总共获得了24条HVR1序列，包括HCV分离株的次要序列群体，这些序列密切相关并被分为五个簇。在这11例患者中，5例感染了多个HCV簇。两名患者在两次检查间隔的18个月期间感染了HCV，这些HVR1序列属于五个簇中的一个。在另一个血液透析中心，20例患者中有5例HCV RNA呈阳性，并且发现两条HVR1序列密切相关且在系统发育上源自同一簇。这些患者对代表基因簇的HVR1肽的抗体反应显示出与系统发育分析完全相同的聚类情况。这些发现表明，对HVR1进行系统发育和血清学分析能够灵敏地检测出血液透析中心同一房间内未被识别的HCV多次传播情况。利用感染因子高变区进行指纹分析有助于确定感染的确切传播途径。
