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血液透析患者丙型肝炎病毒高变区核苷酸序列分析 |
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汪年松 潘卫 竺艳娟 方芳 廖履坦
摘要 目的 探讨维持性血液透析（血透）患者感染丙型肝炎病毒（HCV）的传播途径。方法 应用核苷酸序列分析技术检测15例血透患者感染的HCV高变区（HVR）核苷酸序列，并进行同源性比较。结果 比较15例血透患者HCV HVR核苷酸序列发现，分离株8、12和14间核苷酸序列同源性高达97.00%，株4、5和10间同源性高达95.00%，株1、3～8、10～14相互间同源性均在80.00%以上，这些患者均在同一房间透析或有共用透析机史；株2与其他各株间同源性为61.25%～66.25%，株9与其他各株间同源性57.50%～67.50%,两者均有大量输血史。结论 血透患者感染HCV的主要原因为输血，同时在血透环境中亦可能存在HCV感染的医源性传播途径。
关键词 C型肝炎样病毒属 血液透析 碱基序列 肝炎，丙型 输血
Nucleotide Sequence Analysis for High Variance Region of Hepatitis C Virus in Patients with Hemodialysis
WANG Niansong*, PAN Wei, ZHU Yanjuan, et al.
*Department of Nephrology, Shanghai Sixth People s Hospital, Shanghai 200233
Abstract Objective To investigate the route of transmission for hepatitis C virus （HCV） infection in patients on hemodialysis（HD）. Methods Nucleotide sequence of high variance region （HVR）of HCV was analyzed with nucleotide sequencing technique in 15 HD patients, and its homology was compared. Results Comparison of the nucleotide sequences of HCV HVR in 15 HD patients showed that their homologies in isolates 8, 12 and 14 reached 97.50%, 95.00% in isolates 4, 5 and 10, and more than 80.00% in isolates 1, 3-8 and 10-14. Clinical data showed that all these patients were hemodialyzed in the same room with the same HD machine. Isolates 2 and all others were 61.25%-66.25% in homology, and 57.50%-67.50% in isolates 9 and all others, and both the patients had histories of large-quantity blood transfusion. Conclusion Blood transfusion was the primary risk factor for HCV infection in HD patients, but iatrogenic transmission of HCV through HD environment could also exist.
Key words Hepatitis C-like viruses Hemodialysis Base sequence Hepatitis C Blood transfusion
国外许多研究认为，血液透析（血透）患者感染丙型肝炎病毒（HCV），除了输血外尚存在与透析有关的医源性传播途径［1-4］，但有关报道结论不一致［2-4］，我们采用核苷酸序列测定技术，直接测定部分血透患者感染的HCV高变区（HVR）核苷酸序列，并进行比较，以探讨血透患者感染HCV的传播途径。
对象与方法
一、病例选择
15例血透患者均在中山医院血液净化中心行维持性透析治疗，男7例、[1] [2] [3] 下一页
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