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血液透析人群中消除丙型肝炎病毒感染

甘良英 左力

引用本文:
Citation:

血液透析人群中消除丙型肝炎病毒感染

DOI: 10.12449/JCH240403
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:甘良英负责设计文章框架,起草文稿;左力负责文章修改,定稿。
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    通信作者:

    左力, zuoli@bjmu.edu.cn (ORCID: 0000-0002-7340-5995)

Micro-elimination of hepatitis C virus infection in the hemodialysis population

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    Corresponding author: ZUO Li, zuoli@bjmu.edu.cn (ORCID: 0000-0002-7340-5995)
  • 摘要: 我国血液透析人群呈逐年增长的趋势。由于血液透析治疗的特殊性,血液透析患者的丙型肝炎病毒(HCV)感染的患病率和新发病率都远高于普通人群。为了实现世界卫生组织2030年消除丙型肝炎公共卫生危害的倡议,实现血液透析人群的微消除,应严格执行标准预防,做好手卫生,切断医源性感染的途径,特别是避免血液透析中心的HCV感染暴发;对新入和转换透析中心的患者进行HCV感染筛查,对维持性血液透析患者定期筛查,及早发现HCV新发感染;与专科医生合作,对有HCV感染的血液透析患者进行直接抗病毒药物治疗。

     

  • 表  1  血液透析中心与HCV传播相关的常见感染控制问题14

    Table  1.   Common infection control issues related to HCV transmission in hemodialysis centers14

    感染控制问题
    在污染环境(包括患者治疗区)准备注射用药 将单剂药物瓶重复用于多例患者 使用移动车向患者运送用品或药物 患者间共用的环境表面未充分清洁或消毒 未隔开清洁区域与污染区域 在不同操作或患者间未更换手套或进行手卫生 交接过程匆忙 员工与患者的比例低
    下载: 导出CSV

    表  2  与预防HCV传播相关的标准预防措施14

    Table  2.   Standard precautions related to preventing HCV transmission14

    标准预防措施
    适当的手卫生和更换手套,特别是在接触不同的患者间、进行侵入性操作前以及接触血液和潜在的血液污染表面/用品后
    采用无菌技术在适当的清洁区域准备静脉用药,并进行正确的静脉用药管理
    对透析机表面进行彻底的清洁和消毒,特别是高接触表面
    将干净用品与受污染的材料和设备充分分开
    下载: 导出CSV

    表  3  血液透析患者丙型肝炎监测及诊治一览表15

    Table  3.   List of monitoring, diagnosis and treatment of hepatitis C in hemodialysis patients15

    项目 丙型肝炎
    监测频率 1.新导入或新转入患者即时检测,3个月内复检 2.长期透析患者每6个月1次 3.阳性转阴性患者前6个月每月1次,后6个月每3个月1次 4.新发患者的密切接触者即时检测,3个月内复检 5.不能解释转氨酶异常升高应检测HCV RNA,建议有条件单位检测HCV抗原
    治疗区域安排 1.隔离透析治疗区专机血液透析 2.居家透析治疗
    进入隔离透析区治疗条件 HCV RNA阳性或检测HCV抗原时,HCV抗原阳性
    解除隔离透析区治疗条件 HCV RNA阴性或检测HCV抗原时,HCV抗原阴性
    解除隔离透析治疗方案 1.首次转阴之日起6个月继续在隔离治疗区血液透析 2.持续阴性6个月以上患者,可于非隔离区进行血液透析
    血液透析器/滤器/透析管路复用 不能
    新发传染病上报 24 h内
    下载: 导出CSV

    表  4  透析人群中具有有效证据的DAA列表14

    Table  4.   Direct-acting antiviral (DAA) regimens with evidence of effectiveness for hemodialysis populations14

    DAA HCV基因型 证据质量(总例数)
    Sofosbuvir/Velpatasvir,索磷布韦/维帕他韦(丙通沙),12周 泛基因型 高(405)
    Glecaprevir/Pibrentasvir,格卡瑞韦/哌仑他韦(艾诺全),8周 泛基因型 中(529)
    Sofosbuvir/Daclatasvir,索磷布韦/达拉他韦,12或24周 泛基因型 中(278)
    Sofosbuvir/Ledipasvir,索磷布韦/雷迪帕韦(夏帆宁),12周 泛基因型 中(220)
    Grazoprevir/Elbasvir,格拉瑞韦/艾尔巴韦(择必达),12周 1a,1b,4 中(962)
    PrO±D,奥比帕利/达塞布韦(维建乐/易奇瑞),12周 1a,1b,4 中(582)
    Daclatasvir/Asunaprevir,达拉他韦/阿舒瑞韦(百立泽/速维普),24周 1b 低(341)
    下载: 导出CSV
  • [1] JADOUL M, BIEBER BA, MARTIN P, et al. Prevalence, incidence, and risk factors for hepatitis C virus infection in hemodialysis patients[J]. Kidney Int, 2019, 95( 4): 939- 947. DOI: 10.1016/j.kint.2018.11.038.
    [2] GOODKIN DA, BIEBER B, JADOUL M, et al. Mortality, hospitalization, and quality of life among patients with hepatitis C infection on hemodialysis[J]. Clin J Am Soc Nephrol, 2017, 12( 2): 287- 297. DOI: 10.2215/CJN.07940716.
    [3] Breakthrough One Million/Latest Data on Dialysis Patients in China Released, Heavyweight[EB/OL].( 2023-07-24). https://www.sohu.com/a/705638529_408003. https://www.sohu.com/a/705638529_408003

    突破百万/中国透析患者最新数据新鲜出炉, 重磅![EB/OL].( 2023-07-24). https://www.sohu.com/a/705638529_408003. https://www.sohu.com/a/705638529_408003
    [4] GAN LY, WANG DY, BIEBER B, et al. Hepatitis C prevalence, incidence, and treatment in Chinese hemodialysis patients: Results from the dialysis outcomes and practice patterns study-China(2019-21)[J]. Front Med, 2022, 9: 910840. DOI: 10.3389/fmed.2022.910840.
    [5] MARC L, MIHAESCU A, LUPUSORU R, et al. Hepatitis C and hepatitis B virus infection in hemodialysis patients after nationwide direct antiviral agents therapy-experience of 10 Romanian HD centers[J]. Int Urol Nephrol, 2023, 55( 11): 2951- 2958. DOI: 10.1007/s11255-023-03587-0.
    [6] MIAO XQ, WANG CR, ZENG C, et al. Prevention and control of hepatitis C virus outbreak event in hemodialysis room[J]. Chin J Infect Contr, 2020, 19( 12): 1140- 1144. DOI: 10.12138/j.issn.1671-9638.20206202.

    缪兴全, 王超然, 曾翠, 等. 血液透析室丙型肝炎病毒暴发事件的分析与防控[J]. 中国感染控制杂志, 2020, 19( 12): 1140- 1144. DOI: 10.12138/j.issn.1671-9638.20206202.
    [7] Notice of the National Health Commission on Hepatitis C infection in hemodialysis patients in Dongtai People's Hospital of Jiangsu Province[R/OL]. Network of State Administration and medical administration.( 2019-06-18). http://www.nhc.gov.cn/yzygj/s3594/201906/2d47e45677fe4ff2b12e5afd3eb04891.shtml. http://www.nhc.gov.cn/yzygj/s3594/201906/2d47e45677fe4ff2b12e5afd3eb04891.shtml

    国家卫生健康委关于江苏省东台市人民医院发生血液透析患者感染丙肝事件有关情况的通报[R/OL]. 医政医管网.( 2019-06-18). http://www.nhc.gov.cn/yzygj/s3594/201906/2d47e45677fe4ff2b12e5afd3eb04891.shtml. http://www.nhc.gov.cn/yzygj/s3594/201906/2d47e45677fe4ff2b12e5afd3eb04891.shtml
    [8] CAMPO DS, XIA GL, DIMITROVA Z, et al. Accurate genetic detection of hepatitis C virus transmissions in outbreak settings[J]. J Infect Dis, 2016, 213( 6): 957- 965. DOI: 10.1093/infdis/jiv542.
    [9] Centers for Disease Control and Prevention. Health care-Associated Hepatitis B and C Outbreaks(≥2 cases) Reported to the CDC 2008-2019[S/OL]. Atlanta, GA: Centers for Disease Control and Prevention; 2020. https://www.cdc.gov/hepatitis/outbreaks/healthcarehepoutbreaktable.htm. https://www.cdc.gov/hepatitis/outbreaks/healthcarehepoutbreaktable.htm
    [10] MOHD HANAFIAH K, GROEGER J, FLAXMAN AD, et al. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence[J]. Hepatology, 2013, 57( 4): 1333- 1342. DOI: 10.1002/hep.26141.
    [11] GIROU E, CHEVALIEZ S, CHALLINE D, et al. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit[J]. Clin Infect Dis, 2008, 47( 5): 627- 633. DOI: 10.1086/590564.
    [12] CARRILHO FJ, MORAES CR, PINHO JRR, et al. Hepatitis B virus infection in Haemodialysis Centres from Santa Catarina State, Southern Brazil. Predictive risk factors for infection and molecular epidemiology[J]. BMC Public Health, 2004, 4: 13. DOI: 10.1186/1471-2458-4-13.
    [13] PETROSILLO N, GILLI P, SERRAINO D, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis[J]. Am J Kidney Dis, 2001, 37( 5): 1004- 1010. DOI: 10.1016/s0272-6386(05)80017-4.
    [14] Disease Kidney: Improving Global Outcomes Hepatitis C Work Group. KDIGO 2022 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease[J]. Kidney Int, 2022, 102( 6S): S129- S205. DOI: 10.1016/j.kint.2022.07.013.
    [15] Standard Operating Procedures for Blood Purification(2021). National Health Commission Office‍〔2021〕‍No.552[S/OL].( 2021-11-08). http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml. http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml

    血液净化标准操作规程(2021版). 国卫办医函‍〔2021〕‍552号[S/OL].( 2021-11-08). http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml. http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml
    [16] FISSELL RB, BRAGG-GRESHAM JL, WOODS JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS[J]. Kidney Int, 2004, 65( 6): 2335- 2342. DOI: 10.1111/j.1523-1755.2004.00649.x.
    [17] SAAB S, MARTIN P, BREZINA M, et al. Serum alanine aminotransferase in hepatitis C screening of patients on hemodialysis[J]. Am J Kidney Dis, 2001, 37( 2): 308- 315. DOI: 10.1053/ajkd.2001.21294.
    [18] HUANG CF, DAI CY, WANG CW, et al. Therapy as prevention toward HCV elimination in maintenance hemodialysis: A multi-center, prospective cohort study[J]. Clin Kidney J, 2023, 16( 12): 2429- 2436. DOI: 10.1093/ckj/sfad138.
    [19] LEE JJ, CHANG JM, YANG LJ, et al. Trends of treated hepatitis B, hepatitis C, and tuberculosis infection in long-term hemodialysis patients in Taiwan: A nationwide survey in 2010-2018[J]. J Formos Med Assoc, 2022, 121( Suppl 1): S73- S81. DOI: 10.1016/j.jfma.2021.12.019.
    [20] OKUBO T, ATSUKAWA M, TSUBOTA A, et al. Epidemiological survey of patients with hemodialysis complicated by hepatitis C in Japan[J]. Ther Apher Dial, 2019, 23( 1): 44- 48. DOI: 10.1111/1744-9987.12747.
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