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Clin infect dis:震惊!美国CDC当前指导方针可能漏检高达四分之一的HCV感染病例

2016-04-20 生物谷 梅斯医学

  在一项新的研究中,来自美国约翰霍普金斯医院的研究人员针对来自该医院急诊室的将近5000名患者的血液样品的评估结果提示着美国当前针对丙型肝炎病毒(HCV)的联邦指导方针可能漏检高达四分之一的HCV感染病例,因此要求更新现有的HCV筛查策略。相关研究结果将发表在2016年5月1日那期Clinical Infectious Diseases期刊上,论文标题为“Evaluation

 
在一项新的研究中,来自美国约翰霍普金斯医院的研究人员针对来自该医院急诊室的将近5000名患者的血液样品的评估结果提示着美国当前针对丙型肝炎病毒(HCV)的联邦指导方针可能漏检高达四分之一的HCV感染病例,因此要求更新现有的HCV筛查策略。相关研究结果将发表在2016年5月1日那期Clinical Infectious Diseases期刊上,论文标题为“Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department”。
 
当前,美国疾病控制与预防中心(CDC)推荐对1945年到1965年之间出生的所有成年人或者对具有诸如毒品注射、HIV感染或使用凝血因子之类的高危因素的那些人进行一次HCV测试。但是根据这项新的研究,高达四分之一的感染病例仍然可能不能够确诊,而且研究人员说对在室内急诊室寻求医疗救助的所有美国成年人进行一次普遍测试可能鉴定出更多的人感染上这种病毒然后便对这些人进行管理和治疗。更好的筛选方法也会降低HCV感染传播给他人的风险。
 
2015年11月,约翰霍普金斯医院将它的HCV测试扩大到它的急诊室中所有合格的年龄在18岁及以上的成年人,其中这些人接受抽血作为常规的临床护理的一部分,而且也不知道其血液是否为HCV抗体阳性。约翰霍普金斯医院湾景医学中心(Johns Hopkins Bayview Medical Center)已于2016年2月采取这种测试策略。在这项新的研究中,研究人员特别发现在将近5000例患者中,有将近14%的人经测试为HCV阳性,而且其中的三分之一并未意识到他们感染上这种病毒。
 
“HCV有非常长的临床潜伏期,因此,如果感染上这种病毒,人们可能在5到10年内并没有明显的疾病症状。最终,它破坏很多人的肝脏,能够导致肝癌”, 论文通信作者、约翰霍普金斯大学医学院医学与病理学教授Thomas C. Quinn博士说,“这种感染如果及早检测,能够被治愈,从而使得感染者不再具有传染性,因而阻止与这种病毒相关联的严重后果。然而,我们发现到约翰霍普金斯医院急诊室就诊的人群中,有一大部分人并未记录到也未诊断过HCV感染。”
 
论文第一作者、约翰霍普金斯大学急诊科副教授Yu-Hsiang Hsieh博士补充道,很多具有诸如毒品注射之类的风险因素的人并未将他们的风险信息披露给急诊室工作人员,因此普遍测试是“除CDC推荐之外唯一的尽可能鉴定很多HCV感染病例的方法。”
 
Hsieh说,“我们甚至在年轻的成年患者中发现较高的HCV感染率,这提示着我们需要扩大HCV测试,而不仅仅是针对这种婴儿潮时代出生的人群[编者注:1945年到1965年之间出生的人群]。城市急症室应当考虑扩大CDC推荐的HCV测试范围,从而允许更加强健地鉴定出未知自己感染上HCV的患者。”
 
在这项研究中,研究人员研究了2013年6月到8月到约翰霍普金斯医院就诊的年龄大于17岁的4713名患者的血液样品。在这些患者中,652人(13.8%)为HCV抗体阳性,这意味着他们当前或者之前感染上HCV,而且经测试为阳性的204人(31.3%)之前并未记录过HCV感染。1945年到1965年之间出生的患者的HCV感染率大约是25%,而对这段时间之外出生的患者而言,这一数字是7%。这些婴儿潮时代出生的人也具有较高的未记录的HCV感染率,大约是7%,而对在这段时间之外出生的成年人而言,这一数字是2.6%。非洲裔之外的年龄为18到34岁(1979年到1995年之间出生)的美国男性和女性也具有较高的HCV感染率,高达7.6%。
 
在这204名未记录的HCV感染病例中,128人(63%)是1945年至1965年之间出生的,45人(22%)是毒品注射使用者,10人(5%)已知感染上HIV。研究人员进一步评估后发现基于婴儿潮时代出生的人群进行单次测试可确诊99人(49%);基于修改的CDC风险测试(如毒品注射或已知的HIV感染),还可鉴定出另外54人(26%)。
 
Hsieh说,“如果仅仅依据这些指导方针建立急诊室HIV测试计划,那么在我们的研究期间,将会有51人(25%)的HCV感染未被记录。考虑到经估计一年内有7272名急诊室HCV感染患者,基于婴儿潮时代出生的人群测试将会鉴定出之前未记录的1815名HCV感染病例,但是普遍测试还会鉴定出另外的526名感染病例。”
 
Quinn和Hsieh说,这些结果也强调需要美国联邦和州政府提供管理和治疗资源来资助急症室和HCV患者。Hsieh说,“为每名合格的病人进行HCV测试听起来比较容易,但是这需要很多努力。”
 
在不久的将来,研究人员希望在急诊室环境下研究不同的HCV筛选方法的成本效益,包括普遍测试和CDC推荐的婴儿潮时代出生的人群测试。但是研究人员说,估计单单在美国就有320万人感染上HCV,鉴定、治疗和治愈所有这些病人是至关重要的。
 
Hsieh说,“我们并不常说我们能够治愈一种医学疾病。因此,当我们能够治愈时,我们应当执行一些规定以便允许我们容易鉴定出那些需要帮助的人。”

原始出处:

Yu-Hsiang Hsieh1, Richard E. Rothman1,2, Oliver,et al,Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department,Clin infect dis,2016

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    2016-08-27 李东泽

    这个太吓人了吧,是真是假,求真相

    0

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    2016-08-27 李东泽

    这篇资讯带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。

    0

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    2016-04-22 Lisa971

    指导方针,在临床实践中,仍需不断完善。

    0

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    2016-04-22 ymljack
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    2016-04-22 xugc
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根据在国际肝病会议2016年发布的3期试验结果,对于基因型1型和4型的慢性丙型肝炎,每日一次,固定剂量elbasvir/grazoprevir(50mg/100mg)的片剂组合,比通常使用的治疗方案,即索非布韦(400mg)加聚乙二醇化干扰素和利巴韦林,更有效且更安全。在多中心C-EDGE头对头的研究中,研究人员随机分配255例患者接受12周elbasvir(一种NS5A抑制剂)加grazopre

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近日,一项来自布里斯托大学等机构的研究人员发现,目前全球大约有230万HIV感染者同时还是丙肝感染者(HCV),相关研究刊登于The Lancet Infectious Diseases杂志上。其中有超过一半患者(130万左右)都是注射吸毒者,本文研究发现,相比未感染HIV的个体而言,感染HIV的个体发生丙肝感染的可能性是前者的6倍,这就提示卫生组织个改善HIV/HCV共感染者的相应治疗政策。

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基因型3的(丙型肝炎病毒)HCV感染常常会导致进展期肝病,当前迫切需要有效的治疗。先前有研究表明,达卡他韦(DCV:泛基因型NS5A抑制剂)和索非布韦(SOF:核苷酸NS5B抑制剂)联合治疗非肝硬化HCV基因型3的感染长达12周,有效性达96%。ALLY-3+ Ⅲ期研究评估了DCV-SOF和利巴韦林(RBV)对晚期纤维化(n = 14)或代偿期肝硬化(n = 36)的HCV基因型3感染患者的疗效,

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研究者进行了一项研究,比较< 65岁 vs. ≥ 65岁人群中雷迪帕韦/索非布韦(LDV/SOF)治疗丙型肝炎(HCV)基因型1感染的安全性和有效性。 比较两组间的12周的持续病毒学应答(SVR12)、治疗相关不良事件(AEs)和实验室异常指标。研究共纳入2293名患者,其中264 (12%)名患者≥ 65岁,24名患者≥ 75岁。研究数据显示,< 65岁和≥ 65岁组SVR12分别为

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