癌症输血儿童丙型肝炎病毒抗体的流行

P M Monteleone, C Andrzejewski, J F Kelleher
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摘要

目的:丙型肝炎病毒(HCV)的传播是一种有充分证据的输血并发症,尽管关于输血的癌症儿童的数据很少。在美国,使用一种新的抗HCV抗体检测方法,确定了患有癌症的儿童人群中HCV感染的患病率。患者和方法:对45例接受输血的癌症患儿进行了HCV感染的研究。在接受评估前,患者平均2.3年未接受化疗,平均3.1年未接受输血。检测血清转氨酶[天冬氨酸转氨酶和丙氨酸转氨酶(ALT)]、乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(HBsAb)和乙型肝炎核心抗体(HBcAb)水平。第二代酶免疫分析法(EIA)用于筛选抗hcv抗体。用放射免疫印迹法(RIBA-2)补充阳性eia。结果:无患者HBsAg、HBsAb或HBcAb检测阳性;45例患者中有4例(8.9%)经EIA检测HCV抗体阳性。4人中有3人(占总数的6.7%)在RIBA-2检测中也呈阳性。hcv -阴性和riba -2阳性患者的平均供体暴露次数无显著差异(23.1次vs 61.7次,p = 0.16)。治疗结束后,riba -2阳性组的ALT水平和治疗期间的ALT峰值水平明显高于hcv阴性组,尽管36%的患者(45例中的16例)至少有一次ALT升高超过正常上限的两倍。所有3例riba -2阳性患者都是在1990年献血者普遍筛查HCV之前输血的,并且至少有一次肝肿大。结论:我们已经确定了一小群儿童可能处于发展为慢性活动性肝炎和肝硬化的高风险。丙型肝炎病毒检测应成为接受癌症治疗的儿童长期随访的常规部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence of antibodies to hepatitis C virus in transfused children with cancer.

Purpose: Hepatitis C virus (HCV) transmission is a well-documented complication of blood transfusions, although data on transfused children with cancer is sparse. Using a newer assay for anti-HCV antibodies, the prevalence of HCV infection was determined in a population of children with cancer in the United States.

Patients and methods: Forty-five transfused children with cancer were studied for evidence of HCV infection. Patients had not received chemotherapy for a mean of 2.3 years or transfusions for a mean of 3.1 years before being evaluated. Levels of serum aminotransferases [aspartate aminotransferase and alanine aminotransferase (ALT)], hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) were assessed. A second-generation enzyme immunoassay (EIA) was used to screen for anti-HCV antibodies. Positive EIAs were supplemented by a radioimmunoblot assay (RIBA-2).

Results: No patient tested positively for HBsAg, HBsAb, or HBcAb; four of 45 (8.9%) were positive for HCV antibodies by EIA. Three of the four (6.7% of the total) were also positive by RIBA-2 testing. The mean number of donor exposures was not significantly different between HCV-negative versus RIBA-2-positive patients (23.1 vs. 61.7, p = 0.16). ALT levels off therapy and peak ALT levels during therapy were significantly higher in the RIBA-2-positive group versus the HCV-negative group, although 36% of all patients (16 of 45) had at least one elevation in ALT greater than twice the upper limit of normal. All three RIBA-2-positive patients were transfused before institution of universal screening of blood donors for HCV in 1990 and had hepatomegaly noted at least once.

Conclusions: We have identified a small group of children who may be at high risk for developing chronic active hepatitis and cirrhosis. Testing for HCV should be a routine part of long-term follow-up in children treated for cancer.

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