UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

维持性透析患者中的丙型肝炎病毒感染

Authors
Svetlozar Natov, MD
Brian JG Pereira, MD
Section Editors
Steve J Schwab, MD
Martin S Hirsch, MD
Deputy Editor
Alice M Sheridan, MD
Translators
孙丽华, 主任医师

引言

透析患者中丙型肝炎病毒(hepatitis C virus, HCV)感染较为常见，并且会导致显著并发症发病率和死亡率。

本专题将总结透析患者中HCV感染的流行病学，包括透析单位中HCV传播的危险因素和如何预防传播。肾功减退患者(包括进行透析的患者)中HCV感染的治疗将在别处讨论。 (参见“肾损伤成人患者中慢性丙型肝炎感染的治疗”，关于‘重度肾损伤或透析’一节)

与肾脏移植供者和受者中HCV感染和移植受者中HCV相关性肾脏病的复发或新发相关的一般问题，将在别处讨论。 (参见“肾脏供者的丙型肝炎病毒感染”和“肾移植候选者和受者的丙型肝炎病毒感染”)

流行病学

与健康人群相比，透析患者中HCV感染更为常见。关于透析患者中HCV感染的流行情况，透析预后和实践模式研究(Dialysis Outcomes and Practice Patterns Study, DOPPS)提供的数据质量最好，该项研究为前瞻性观察研究，研究从法国、德国、意大利、日本、西班牙、英国和美国的308所代表性透析机构中随机选取血液透析成人患者，报告了这些患者中的HCV感染率[1]。该研究中HCV的感染率为13.5%，全球总人群中HCV感染率约为3%。 (参见“丙型肝炎病毒感染的流行病学与传播”，关于‘全球分布’一节)

DOPPS报告的各国透析患者间的HCV感染率存在较大差异，范围为2.6%-22.9%。在不同研究中，所报道的不同国家的透析患者中，HCV抗体阳性率分别是：

      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-05-15.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004; 65:2335.
  2. Finelli L, Miller JT, Tokars JI, et al. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005; 18:52.
  3. Fabrizi F, Lunghi G, Raffaele L, et al. Serologic survey for control of hepatitis C in haemodialysis patients: third-generation assays and analysis of costs. Nephrol Dial Transplant 1997; 12:298.
  4. Biamino E, Caligaris F, Ferrero S, et al. [Prevalence of anti-HCV antibody positivity and seroconversion incidence in hemodialysis patients]. Minerva Urol Nefrol 1999; 51:53.
  5. Di Napoli A, Pezzotti P, Di Lallo D, et al. Epidemiology of hepatitis C virus among long-term dialysis patients: a 9-year study in an Italian region. Am J Kidney Dis 2006; 48:629.
  6. Couroucé AM, Bouchardeau F, Chauveau P, et al. Hepatitis C virus (HCV) infection in haemodialysed patients: HCV-RNA and anti-HCV antibodies (third-generation assays). Nephrol Dial Transplant 1995; 10:234.
  7. Covic A, Iancu L, Apetrei C, et al. Hepatitis virus infection in haemodialysis patients from Moldavia. Nephrol Dial Transplant 1999; 14:40.
  8. Othman B, Monem F. Prevalence of antibodies to hepatitis C virus among hemodialysis patients in Damascus, Syria. Infection 2001; 29:262.
  9. Kamar N, Ribes D, Izopet J, Rostaing L. Treatment of hepatitis C virus infection (HCV) after renal transplantation: implications for HCV-positive dialysis patients awaiting a kidney transplant. Transplantation 2006; 82:853.
  10. Tokars JI, Miller ER, Alter MJ, Arduino MJ. National surveillance of dialysis associated diseases in the United States, 1995. ASAIO J 1998; 44:98.
  11. Geerlings W, Tufveson G, Ehrich JH, et al. Report on management of renal failure in Europe, XXIII. Nephrol Dial Transplant 1994; 9 Suppl 1:6.
  12. Valderrábano F, Jones EH, Mallick NP. Report on management of renal failure in Europe, XXIV, 1993. Nephrol Dial Transplant 1995; 10 Suppl 5:1.
  13. Jadoul M, Poignet JL, Geddes C, et al. The changing epidemiology of hepatitis C virus (HCV) infection in haemodialysis: European multicentre study. Nephrol Dial Transplant 2004; 19:904.
  14. Tokars JI, Miller ER, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 1997. Semin Dial 2000; 13:75.
  15. Baid-Agrawal S, Schindler R, Reinke P, et al. Prevalence of occult hepatitis C infection in chronic hemodialysis and kidney transplant patients. J Hepatol 2014; 60:928.
  16. Pereira BJ, Levey AS. Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int 1997; 51:981.
  17. Espinosa M, Martn-Malo A, Ojeda R, et al. Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J Kidney Dis 2004; 43:685.
  18. Natov SN, Lau JY, Bouthot BA, et al. Serologic and virologic profiles of hepatitis C infection in renal transplant candidates. New England Organ Bank Hepatitis C Study Group. Am J Kidney Dis 1998; 31:920.
  19. Donahue JG, Muñoz A, Ness PM, et al. The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med 1992; 327:369.
  20. Cendoroglo Neto M, Draibe SA, Silva AE, et al. Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among haemodialysis and CAPD patients: evidence for environmental transmission. Nephrol Dial Transplant 1995; 10:240.
  21. Weinstein T, Tur-Kaspa R, Chagnac A, et al. Hepatitis C infection in dialysis patients in Israel. Isr Med Assoc J 2001; 3:174.
  22. dos Santos JP, Loureiro A, Cendoroglo Neto M, Pereira BJ. Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units. Nephrol Dial Transplant 1996; 11:2017.
  23. Jadoul M, Cornu C, van Ypersele de Strihou C. Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study. The UCL Collaborative Group. Kidney Int 1993; 44:1322.
  24. Petrosillo N, Gilli P, Serraino D, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001; 37:1004.
  25. Bergman S, Accortt N, Turner A, Glaze J. Hepatitis C infection is acquired pre-ESRD. Am J Kidney Dis 2005; 45:684.
  26. DuBois DB, Gretch D, dela Rosa C, et al. Quantitation of hepatitis C viral RNA in sera of hemodialysis patients: gender-related differences in viral load. Am J Kidney Dis 1994; 24:795.
  27. Jeffers LJ, Perez GO, de Medina MD, et al. Hepatitis C infection in two urban hemodialysis units. Kidney Int 1990; 38:320.
  28. Alter MJ, Margolis HS, Krawczynski K, et al. The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med 1992; 327:1899.
  29. Stuyver L, Claeys H, Wyseur A, et al. Hepatitis C virus in a hemodialysis unit: molecular evidence for nosocomial transmission. Kidney Int 1996; 49:889.
  30. Halfon P, Roubicek C, Gerolami V, et al. Use of phylogenetic analysis of hepatitis C virus (HCV) hypervariable region 1 sequences to trace an outbreak of HCV in an autodialysis unit. J Clin Microbiol 2002; 40:1541.
  31. Grethe S, Gemsa F, Monazahian M, et al. Molecular epidemiology of an outbreak of HCV in a hemodialysis unit: direct sequencing of HCV-HVR1 as an appropriate tool for phylogenetic analysis. J Med Virol 2000; 60:152.
  32. Olmer M, Bouchouareb D, Zandotti C, et al. Transmission of the hepatitis C virus in an hemodialysis unit: evidence for nosocomial infection. Clin Nephrol 1997; 47:263.
  33. Sypsa V, Psichogiou M, Katsoulidou A, et al. Incidence and patterns of hepatitis C virus seroconversion in a cohort of hemodialysis patients. Am J Kidney Dis 2005; 45:334.
  34. Jadoul M, Fabrizi F. What are the management issues for hepatitis C in dialysis patients?: epidemiology and prevention of hepatitis C virus transmission in the hemodialysis setting. Semin Dial 2014; 27:449.
  35. Kiyosawa K, Sodeyama T, Tanaka E, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med 1991; 115:367.
  36. Mitsui T, Iwano K, Masuko K, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992; 16:1109.
  37. Alter MJ. The epidemiology of acute and chronic hepatitis C. Clin Liver Dis 1997; 1:559.
  38. Lanphear BP, Linnemann CC Jr, Cannon CG, et al. Hepatitis C virus infection in healthcare workers: risk of exposure and infection. Infect Control Hosp Epidemiol 1994; 15:745.
  39. Puro V, Petrosillo N, Ippolito G. Risk of hepatitis C seroconversion after occupational exposures in health care workers. Italian Study Group on Occupational Risk of HIV and Other Bloodborne Infections. Am J Infect Control 1995; 23:273.
  40. Okuda K, Hayashi H, Kobayashi S, Irie Y. Mode of hepatitis C infection not associated with blood transfusion among chronic hemodialysis patients. J Hepatol 1995; 23:28.
  41. Gilli P, Moretti M, Soffritti S, et al. Non-A, non-B hepatitis and anti-HCV antibodies in dialysis patients. Int J Artif Organs 1990; 13:737.
  42. Centers for Disease Control and Prevention (CDC). Hepatitis C virus transmission at an outpatient hemodialysis unit--New York, 2001-2008. MMWR Morb Mortal Wkly Rep 2009; 58:189.
  43. Alfurayh O, Sabeel A, Al Ahdal MN, et al. Hand contamination with hepatitis C virus in staff looking after hepatitis C-positive hemodialysis patients. Am J Nephrol 2000; 20:103.
  44. Niu MT, Alter MJ, Kristensen C, Margolis HS. Outbreak of hemodialysis-associated non-A, non-B hepatitis and correlation with antibody to hepatitis C virus. Am J Kidney Dis 1992; 19:345.
  45. Garcia-Valdescasas J, Bernal MC, Cerezo S, et al. Strategies to reduce the transmission of HCV infection in hemodialysis (HD) units (abstract). J Am Soc Nephrol 1993; 4:347.
  46. Jadoul M, Cornu C, van Ypersele de Strihou C. Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group. Kidney Int 1998; 53:1022.
  47. Froio N, Nicastri E, Comandini UV, et al. Contamination by hepatitis B and C viruses in the dialysis setting. Am J Kidney Dis 2003; 42:546.
  48. Brugnano R, Francisci D, Quintaliani G, et al. Antibodies against hepatitis C virus in hemodialysis patients in the central Italian region of Umbria: evaluation of some risk factors. Nephron 1992; 61:263.
  49. Mitwalli A, al-Mohaya S, al Wakeel J, et al. Hepatitis C in chronic renal failure patients. Am J Nephrol 1992; 12:288.
  50. Rais-Jalali G, Khajehdehi P. Anti-HCV seropositivity among haemodialysis patients of Iranian origin. Nephrol Dial Transplant 1999; 14:2055.
  51. Vagelli G, Calabrese G, Guaschino R, Gonella M. Effect of HCV+ patients isolation on HCV infection incidence in a dialysis unit. Nephrol Dial Transplant 1992; 7:1070.
  52. Calabrese G, Vagelli G, Guaschino R, Gonella M. Transmission of anti-HCV within the household of haemodialysis patients. Lancet 1991; 338:1466.
  53. Taskapan H, Oymak O, Dogukan A, Utas C. Patient to patient transmission of hepatitis C virus in hemodialysis units. Clin Nephrol 2001; 55:477.
  54. Taal MW, van Zyl-Smit R. Hepatitis C virus infection in chronic haemodialysis patients--relationship to blood transfusions and dialyser re-use. S Afr Med J 2000; 90:621.
  55. Hubmann R, Zazgornik J, Gabriel C, et al. Hepatitis C virus--does it penetrate the haemodialysis membrane? PCR analysis of haemodialysis ultrafiltrate and whole blood. Nephrol Dial Transplant 1995; 10:541.
  56. Caramelo C, Navas S, Alberola ML, et al. Evidence against transmission of hepatitis C virus through hemodialysis ultrafiltrate and peritoneal fluid. Nephron 1994; 66:470.
  57. Noiri E, Nakao A, Oya A, et al. Hepatitis C virus in blood and dialysate in hemodialysis. Am J Kidney Dis 2001; 37:38.
  58. Lombardi M, Cerrai T, Dattolo P, et al. Is the dialysis membrane a safe barrier against HCV infection? Nephrol Dial Transplant 1995; 10:578.
  59. Castelnovo C, Sampietro M, De Vecchi A, et al. Diffusion of HCV through peritoneal membrane in HCV positive patients treated with continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 1997; 12:978.
  60. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001; 50:1.
  61. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008; :S1.
  62. Natov SN, Pereira BJG. Transmission of disease by organ transplantation. In: Organ and Tissue Donation for Transplantation, Chapman JD, Deierhoi M, Wight C (Eds), Edward Arnold, London 1996.
  63. Fabrizi F, Martin P, Dixit V, et al. Meta-analysis: Effect of hepatitis C virus infection on mortality in dialysis. Aliment Pharmacol Ther 2004; 20:1271.
  64. Terrault NA, Adey DB. The kidney transplant recipient with hepatitis C infection: pre- and posttransplantation treatment. Clin J Am Soc Nephrol 2007; 2:563.
  65. Fabrizi F, Martin P, Lunghi G, Locatelli F. Membrane compatibility, flux and HCV infection in dialysis patients: newer evidence. Int J Artif Organs 2000; 23:296.
  66. Stehman-Breen CO, Emerson S, Gretch D, Johnson RJ. Risk of death among chronic dialysis patients infected with hepatitis C virus. Am J Kidney Dis 1998; 32:629.
  67. Pereira BJ, Natov SN, Bouthot BA, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1998; 53:1374.
  68. Nakayama E, Akiba T, Marumo F, Sato C. Prognosis of anti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy. J Am Soc Nephrol 2000; 11:1896.
  69. Seeff LB, Buskell-Bales Z, Wright EC, et al. Long-term mortality after transfusion-associated non-A, non-B hepatitis. The National Heart, Lung, and Blood Institute Study Group. N Engl J Med 1992; 327:1906.
  70. Marcelli D, Stannard D, Conte F, et al. ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. Kidney Int 1996; 50:1013.