Fabrizi F, Martin P, Dixit V, Brezina M, Cole M J, Gerosa S, Vinson S, Mousa M, Gitnick G
Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, Calif., USA.
Nephron. 1998 Dec;80(4):428-33. doi: 10.1159/000045215.
Recent evidence has been accumulated showing that chronic hemodialysis (HD) patients have a very high prevalence of antibodies to hepatitis C virus (HCV). In contrast, there is little information addressing the virological characteristics of HCV infection in this population.
To measure HCV viral load and to correlate this with demographic, biochemical, and clinical features of a large cohort of HCV-infected patients on chronic HD.
394 chronic HD patients were tested by branched-DNA signal amplification assay, anti-HCV enzyme-linked immunosorbent assay 2.0, and on the basis of the aspartate aminotransferase/alanine aminotransferase (AST/ALT) activity. Multivariate analysis by ordinal logistic regression model was performed: age, gender, race, time on HD, allocation of the patients among the HD units, etiology of end-stage renal disease, HBsAg status, anti-HCV positivity, HCV genotype, and AST/ALT levels were independent factors, and viremic levels of HCV in serum were assumed as dependent variables.
88 (22.3%) patients showed serological and/or virological signs of HCV infection. 59 (15%) out of 394 had detectable HCV RNA in serum, the mean HCV load was 19.4 x 10(5) (95% CI, 6.06 x 10(7) to 6.2 x 10(4)) Eq/ml. According to the criteria suggested by others [J Infect Dis 1994;169:1219-1225], there were 8 (13.5%) individuals with high-titer viremia (>1 x 10(7) Eq/ml) in the subset of viremic patients. A small subset (8/394 or 2%) of individuals was seronegative, but viremic; 29 (7%) out of 394 were seropositive without detectable HCV RNA in serum. Univariate analysis showed that the frequency of anti-HCV positivity was significantly higher in viremic patients as compared with individuals with no detectable HCV viremia: 51/59 (86%) vs. 29/335 (8.6%), p = 0.0001. Serum AST and ALT levels were significantly higher in viremic patients than in individuals with no detectable HCV RNA in serum: 23.8 (95% CI 60.8-9.3) vs. 17.1 (95% CI 50.4-5.8) U/l (p = 0.009) and 14.4 (95% CI 48.9-4.3) vs. 9.8 (95% CI, 37.3- 2. 5) U/l (p = 0.008). Logistic regression analysis showed an association between HCV viremia and anti-HCV positivity (p = 0. 00001) and ALT activity (p = 0.01).
Hepatitis C virus infection is highly prevalent in the HD population; the viral load is relatively low, and it was associated with elevated hepatic enzyme levels and anti-HCV positivity. No other clinical characteristics were associated with HCV RNA levels. Seronegative but viremic patients were also found. Longitudinal studies with long follow-up periods are necessary to evaluate the course of HCV load over time in this population.
最近积累的证据表明，慢性血液透析（HD）患者中丙型肝炎病毒（HCV）抗体的患病率非常高。相比之下，关于该人群中HCV感染的病毒学特征的信息很少。
测量HCV病毒载量，并将其与一大群接受慢性HD的HCV感染患者的人口统计学、生化和临床特征相关联。
采用分支DNA信号扩增检测法、抗HCV酶联免疫吸附测定2.0以及基于天冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）活性，对394例慢性HD患者进行检测。通过有序逻辑回归模型进行多变量分析：年龄、性别、种族、HD治疗时间、患者在HD单位之间的分配、终末期肾病的病因、HBsAg状态、抗HCV阳性、HCV基因型和AST/ALT水平为独立因素，血清中HCV的病毒血症水平作为因变量。
88例（22.3%）患者表现出HCV感染的血清学和/或病毒学迹象。394例中有59例（15%）血清中可检测到HCV RNA，平均HCV载量为19.4×10⁵（95%可信区间，6.06×10⁷至6.2×10⁴）Eq/ml。根据其他人提出的标准[《传染病杂志》1994年；169：1219 - 1225]，在病毒血症患者亚组中有8例（13.5%）个体具有高滴度病毒血症（>1×10⁷Eq/ml）。一小部分个体（8/394或2%）血清学阴性但病毒血症阳性；394例中有29例（7%）血清学阳性但血清中未检测到HCV RNA。单变量分析显示，与未检测到HCV病毒血症的个体相比，病毒血症患者中抗HCV阳性的频率显著更高：51/59（86%）对29/335（8.6%），p = 0.0001。病毒血症患者的血清AST和ALT水平显著高于血清中未检测到HCV RNA的个体：23.8（95%可信区间60.8 - 9.3）对17.1（95%可信区间50.4 - 5.8）U/l（p = 0.009）以及14.4（95%可信区间48.9 - 4.3）对9.8（95%可信区间，37.3 - 2.5）U/l（p = 0.008）。逻辑回归分析显示HCV病毒血症与抗HCV阳性（p = 0.00001）和ALT活性（p = 0.01）之间存在关联。
丙型肝炎病毒感染在HD人群中高度流行；病毒载量相对较低，且与肝酶水平升高和抗HCV阳性相关。没有其他临床特征与HCV RNA水平相关。也发现了血清学阴性但病毒血症阳性的患者。需要进行长期随访的纵向研究来评估该人群中HCV载量随时间的变化过程。
