上海地区638例输血后丙型肝炎病毒感染者的临床分析

徐国光; 巫善明; 周霞秋; 张清波; 康来仪; 周晓明; 蒋音; 戚勋; 任晓静

Abstract

徐国光,巫善明,周霞秋,张清波,康来仪,周晓明,蒋音,戚勋,任晓静.上海地区638例输血后丙型肝炎病毒感染者的临床分析[J].Chinese journal of Epidemiology,2011,32(4):388-391

上海地区638例输血后丙型肝炎病毒感染者的临床分析

Clinical characteristics of 638 patients Infected with hepatitis Cvirus by post blood transfusion.in Shanghai

Received:October 18, 2010

DOI：

KeyWord: 丙型肝炎病毒输血后感染临床特征

English Key Word: Hepatitis C virus Post transfusion infection Clinical characteristics

FundProject:上海市(复旦大学附属)公共卫生临床中心科研基金(200805)

Author Name	Affiliation	E-mail
Xu Guoguang	Shanghai Public Health Clinical Center, Fudan Unb：ersity, Shanghai 201508, China	ggxudoctor@sina.com
Wu Shanming	Shanghai Public Health Clinical Center, Fudan Unb：ersity, Shanghai 201508, China
Zhou Xiaqiu	Ruin Hospital, Shanghai Jiaotong Univers
Zhang Qingbo	Huashan Hospital, Shanghai Fudan University
Kang Laiyi	Shanghai Municipal Centerfor Disease Control and Prevention
Zhou Xiaomuing	Shanghai Public Health Clinical Center, Fudan Unb：ersity, Shanghai 201508, China
Jiang Yin	Shanghai Public Health Clinical Center, Fudan Unb：ersity, Shanghai 201508, China
Qi Xun	Shanghai Public Health Clinical Center, Fudan Unb：ersity, Shanghai 201508, China
Renb Xiaojing	Shanghai Public Health Clinical Center, Fudan Unb：ersity, Shanghai 201508, China

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Abstract:

目的分析输血后丙型肝炎病毒(HCV)感染者的临床特征。方法采用PCR检测HCVRNA载量，ELISA检测抗一HCV，分析输血后HCV感染者的年龄、原发病因、暴露年份、输血成分与输血量、潜伏期、肝功能损害和腹部超声图像改变等。结果578例感染者中有525例(90．8％)HCV RNA载量>f3．0 log。copy／ml(M=6．10 log。。copy／m1)，其中19．2％病例为30—40 l0910copy／ml、66．1％为5．0—6．0loglo copy／ml，仅14．7％病例／>7．0logIo copy／ml。HCVRNA定性阳性率为81．5％(44／54)，HCV基因型主要为l型，抗一HCV阳性率达99．8％(636／637)，其阳性敏感率高于HCV RNA定量和定性检测(均为P----0．000)。输血后HCV感染以40一60岁年龄段多见，85．7％病例的暴露时间为1990—1994年。10％以上的感染者中基础疾病为妇产科、骨科疾病和胃肠道出血，79．9％的病例为输入全血者，输血至临床诊断时间平均(8．5±5．5)年；90．1％感染者有肝功能损害，多数病例血清丙氨酸氨基转移酶(ALT)升高水平≤5×ULN，而血清总胆红素升高、ALT和天冬氨酸氨基转氨酶>15×ULN水平者临床表现较多(P值分别为0．000、0．001和O．009)；8．9％感染者腹部超声显示有肝硬化改变，但多见于感染期>5年者。结论输血后HCV感染主要集中于1990—1994年，成年人患病率较高。常伴有肝功能损害，感染期>5年者肝硬化发生率较高。HCV基因型主要为l型，血清HCVRNA载量多为中等水平。

English Abstract:

Objective To investigate the clinical-epidemiologic characteristics of patients with hepatitis C virus(HCV)infection by POst blood transfusion．Methods Polymerase chain reaction (PCR)and enzyTne Iinked immunosorbent assay(ELISA)were used to detect HCV RNA and anti-HCV，respectively．Analysis was performed on patients’age distribution，cause of primary diseases，years of exposure,inedient and amount of transfusion．incubation period，disorder on liver function and changes on abdominal ultrasound image．etc．Results HCV RNA levels were higher than 30 log₁₀ eopy／ml in 90．8％infected patients、Ⅳith a median as 6．10 loglo copy／m1．19．2％of the patients showed vimlload 3．0 to 4．0 loglo copy／ml，and 66．1％ofthem showed 5．O to 6．0 loglo copy／m1．Only 14．7％of the infected persons had HCV RNA levels higllel-than 7．0 loglo copy／m1．Eighty—one point five percent(44/54)of the infected persons were confirmed as HCV RNA positive by HCV RNA qualitative analysis with HCV genotyce as primariiy type 1．99．8％(636／637)of the patients were detected as anti-HCV positive by serological test．The sensitivity of scrologieal test Was higher than both quantitative and qualitative HCV RNA assays(P=0000，P-----0000，respectively)．HCV infection POst blood transfusion Was more seen in common people at 40 to 60 years old Most cases(85．7％)had their first exposure during 1990 to 1994．More than 10％ofthe cases had primary diseases as obstetrics．orthopedics or gastrointestinal tract hemorrhage．79．9％of the patients received whole blood product transfusion．111e mean interval between transfusion and clinical diagnosis Was 8．5±5．5 years．90．1％of the infected patients had liver function damage，while most of them showed elevated alanine aminotransferase(ALT)no more than 5 upper Iimits of norrnal(ULN)．wheleas Serum toml bilimbin(TBIL)．ALT and aspartate aminotransferase(AST)≥5×ULN level were showing more clinicaI manifestations (P=0．000．P=0．001，P--0．009，respectively)．Abdominal ultrasound among 8．9％of the irifected persons showed changes in cirrhosis，and most of them were older than 50 years of age．Conclusion Most of the post transfusion HCV infected cases happened in adulthood.and WeI'e mainly exposed during 1990 to 1994．Irifected patients usually had their livfff function damaged with elevated ALT no more than 5×ULN and with medium HCV RNA levels．HCV genotype Was mainly for type 1．Patients who were of older age showed higher incidence of cirrhosis． If a patients’infection period WaS longer than 5 years，he／she would show higher incidence of cirrhosis．

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