标题：维持性血液透析患者丙型肝炎病毒感染血清学诊断方法的比较

      作者：黎嘉敏 1，何永成 1，曾劲锋 2，卢 亮 2，李 彤 1
    （1.深圳市第二人民医院肾内科，广东 深圳 518035；
2.深圳市血液中心检验科，广东 深圳 518037）

      卷次： 2013年24卷13期

      【摘要】 目的 比较丙型肝炎病毒（HCV）感染的血清学诊断方法，探索诊断维持性血液透析患者HCV感
染的可靠方法。方法 分别使用国产和进口HCV抗体试剂盒检测抗-HCV，使用TMA法定性检测HCV-RNA，
荧光定量PCR法定量检测HCV-RNA，比较各种诊断方法对HCV的检出率，评价ALT变化与HCV-RNA载量的
关系，评价抗-HCV S/CO值与HCV-RNA载量的关系。结果 国产和进口试剂检测抗-HCV的检出率均为7.3%
(P=1.000)；TMA法检测HCV-RNA的检出率为9.5%，免疫荧光定量PCR法的检出率为5.6%，两者之间差异无统
计学意义(P=0.330)；单独检测HCV-RNA比单独检测抗-HCV的检出率高，两者差异有统计学意义(P=0.000)；联
合检测抗-HCV和HCV-RNA的检出率为 10.6%，与单独检测抗-HCV相比较差异有统计学意义(P=0.000)。
HCV-RNA的载量和ALT的变化无相关性(r=0.189，P=0.536)；抗-HCV初筛的S/CO值与HCV-RNA载量无相关性
(r=0.174，P=0.569)。结论 检测HCV-RNA能缩短HCV感染后检出的窗口期，以便更早诊断维持性血液透析患
者HCV感染，联合检测抗-HCV和HCV-RNA能避免漏诊处于血清转换期或慢性病毒携带的患者。ALT的变化
和HCV载量无明显相关性，在血液透析患者中辅助早期诊断HCV感染的作用较小。

      【关键词】 维持性血液透析；丙型肝炎病毒；抗-HCV；HCV-RNA

      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2013）13—1941—05


Comparison of serological diagnosis methods of hepatitis C virus infection in maintenance hemodialysis
patients.
LI Jia-min 1, HE Yong-cheng 1, ZENG Jin-feng 2, LU Liang 2, LI Tong 1. 1. Department of Nephrology,
Shenzhen Second People's Hospital, Shenzhen 518035, Guangdong, CHINA; 2. Department of Clinical Laboratory,
Shenzhen Blood Center, Shenzhen 518037, Guangdong, CHINA

【Abstract】 Objective To compare the serological diagnosis methods of hepatitis C virus (HCV) infection,
and explore the reliable method to diagnosis HCV infection in maintenance hemodialysis patients. Methods Domes-
tic and imported HCV 3.0 ELISA test system were used to detect HCV antibody respectively. HCV-RNA was tested
by TMA qualitatively and fluorescence quantitative PCR quantitatively. The positive rates of various diagnosis meth-
ods for detection of HCV were compared, and the relationship of ALT and HCV viral load was evaluated, as well as
the relationship between anti-HCV S/CO value and HCV viral load. Results The positive rate of anti-HCV both us-
ing domestic and imported diagnostic kits was 7.3%, with no statistically significant difference (P=1.000). The posi-
tive rate of HCV-RNA was 8.9% by TMA and 5.6% by fluorescence quantitative PCR, with no statistically significant
difference (P=0.330). The positive rate was 10.6% when it is detected by both anti-HCV and HCV-RNA qualitatively,
and there was statistically significant difference compared with the detection of anti-HCV alone (P=0.000). No correla-
tion was found between the change of ALT and HCV viral load (r=0.189, P=0.536). Similarly, S/CO ratio of anti-HCV
has nothing to do with HCV viral load (r=0.174, P=0.569）. Conclusion Detection of HCV-RNA can shorten the win-
dow period after HCV infection, and helps diagnose the HCV infection earlier in the hemodialysis patients. Combined
detection of anti-HCV can avoid misdiagnosis for the patients in the serum transition or chronic infection period. No
obvious relevance between the change of ALT and HCV viral load is found, so ALT affected slightly in assisting diag-
nosis of HCV infection.