ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2017, Vol. 26 ›› Issue (5): 438-441.DOI: 10.3969/cndt.j.issn.1006-298X.2017.05.008

• 论文 • 上一篇    下一篇

 维持性血液透析患者隐匿性乙型肝炎病毒感染的调查与分析

  

  • 出版日期:2017-10-28 发布日期:2017-10-27

Prevalence of occult hepatitis B virus infection in maintenance hemodialysis patients

  • Online:2017-10-28 Published:2017-10-27

摘要:

目的:旨在评估维持性血液透析(MHD)患者中隐匿性乙型肝炎病毒(HBV)感染(OBI)情况。
方法:对2014年12月至2015年12月四川省人民医院血液透析中心的MHD患者采用ELISA法检测HBV标记物,并对HBsAg(-)/HBcAb(+)患者进行实时定量荧光PCR(realtime PCR)检测HBVDNA,了解OBI的患病率。
结果:(1)入选本中心MHD患者330例,平均年龄6066±1432岁,男性557%,女性443%; HBV患病率为73%(24/330),545%(180/330)为既往感染过HBV[HBsAg(-)/HBcAb(+)];(2)共收集到165例既往感染过HBV患者的血浆标本进行HBVDNA检测,发现7例阳性,水平均很低(<20 IU/ml),所以OBI的患病率对于进行检测的患者来说为42%(7/165),对于整个透析中心患者来说为22%(7/315);(3)将7例OBI患者作为观察组,剩下158例HBVDNA(-)患者作为对照组进行比较发现,男性OBI比例更高(P=0042),疫苗接种可预防OBI(P=0010);(4)单一HBcAb(+)患者(65%)比HBcAb(+)/HBsAb(+)患者(38%)具有更高的OBI患病率,但两者间无明显统计学差异(P=0617)。
结论:本组MHD患者中545%既往感染过HBV,目前OBI患病率为22%,且HBVDNA水平低下,但仍有引起病毒传播的风险,特别是单一HBcAb(+)患者。

Abstract:

To investigate the prevalence of occult hepatitis B virus (HBV) infection (OBI) in maintenance hemodialysis (MHD) patients.
Methodology:MHD patients in our dialysis units from December 2014 to December 2015 were enrolled. HBV marker was examined by ELISA. The sera from HBcAb (+)/HBsAg (-) individuals were tested for HBVDNA by a realtime quantitative PCR to investigate the prevalence of OBI.
Results:(1)They were three hundred and thirty patients, 557% were male and 443% were female with a mean age of 607±143 years. 24 (73%) patients had chronic HBV infection (HBsAg positive). 180 (545%) patients were HBcAb (+)/HBsAg (-) which suggested past infection. (2)Plasma samples of 165 patients with past HBV infection were obtained for HBVDNA detection. Elevated HBVDNA level (<20 IU/ml) was detected in 7 (42%) patients, therefore the prevalence of OBI was 22% (7/315) in all the dialysis patients. (3)Comparing the 7 patients with OBI, it was found that male were more prone to OBI (P=0042), and vaccination may be effective in preventing OBI (P=0010) in the 158 patients who were HBVDNA negative. (4)The prevalence of OBI in HBcAb (+)/HBsAb (-) patients (65%) was higher than that in HBcAb (+)/HBsAb (+) patients (38%), but the difference was not significant (P=0617).
Conclusion:
545% of MHD patients in our center had evidence of past HBV infection, and the prevalence of OBI was 22% with very low level of HBVDNA. However, there may be a potential risk that the patients with OBI may transmit infection within dialysis units, especially when the patient was  HBcAb (+)/HBsAb (-).