摘要目的 探讨在人类免疫缺陷病毒(HIV)流行新形势下,志愿无偿献血模式的安全性.方法 选择2008年1月至2012年12月于深圳市采供血机构献血的438 123例志愿无偿献血者作为研究对象.根据《献血者健康检查要求》(GB 18467-2011)对献血者分类的定义,将无偿献血者分为3组:固定献血组(n=87 460),不定期献血组(n=67 812)和初次献血组(n=282 851).血液HIV初筛检测采用酶联免疫吸附法测定,反应性标本采用Western免疫印迹法确认.分析比较2008-2012年深圳市不同类型志愿无偿献血者HIV感染分布情况及变化趋势.结果 2008-2012年深圳市采供血机构固定献血组人群的HIV感染率分别为0.0/10万、0.0/10万、17.1/10万、10.5/10万、9.8/10万,HIV总感染率为8.0/10万,总体处于平稳的低流行状态(x2=1.664,P＞0.05);不定期献血组人群的HIV感染率分别为25.0/10万、32.1/10万、60.0/10万、69.6/10万、57.4/10万,HIV总感染率为50.1/10万,处于平稳的较高流行状态(x2=2.606,P＞0.05);初次献血组人群的HIV感染率分别为15.6/10万、14.3/10万、42.3/10万、62.7/10万、67.4/10万,HIV总感染率为42.8/10万,于2010年起呈逐年增长趋势(x2=30.327,P＜0.01).不定期献血组HIV感染率最高(50.1/10万),其次为初次献血组(42.8/10万),但两组相比,差异无统计学意义(x2=0.67,P＞0.05).固定献血组HIV感染率最低(8.0/10万),与不定期献血组、初次献血组分别相比,差异均有统计学意义(x2 =25.69,23.38;P＜0.01).结论 深圳市志愿无偿献血人群HIV感染流行趋势呈现出新的态势,仅通过提高固定志愿无偿献血队伍的数量已不能充分保障血液安全.应采用高灵敏度的核酸检测、系统性地加强志愿无偿献血者的健康教育、高度重视献血者健康评估和重视招募集体献血人群等手段进一步保障血液安全.

abstractsObjective To explore suitable strategy for blood donation safety under human immunodeficiency virus (HIV) infection new situation.Methods From January 2008 to December 2012,a total of 438 123 voluntary unpaid blood donors in Shenzhen Blood Station were included in this study.According to the definition of classification of blood donors in Whole blood and component donor selection requirements (GB 18467-2011),all the donors were classified into 3 groups:regular voluntary blood donors group (n =87 460),unfixed voluntary blood donors group (n =67 812),and primary voluntary blood donors group (n=282 851).Their blood samples were screened by enzyme-linked immunosorbent assay (ELISA) test and confirmed by Western blotting (WB) test.The distribution and variation trend of their HIV infection rates were analyzed and compared.Results The HIV infection rates of regular voluntary blood donors group from 2008 to 2012 were 0.0,0.0,17.1,10.5 and 9.8 per 100 000,respectively.Total HIV infection rate was 8.0 per 100 000.Regular voluntary blood donors were in a stable state of low prevalence (x2 =1.664,P＞0.05).HIV infection rates of unfixed voluntary blood donors group were 25.0,32.1,60.0,69.6 and 57.4 per 100 000,respectively.The total rate was 50.1 per 100 000.Unfixed voluntary blood donors were in a stable state of high prevalence (x2 =2.606,P＞0.05).HIV infection rates of primary voluntary blood donors group were 15.6,14.3,42.3,62.7 and 67.4 per 100 000,respectively.The total rate was 42.8 per 100 000.HIV infection trends of primary voluntary blood donors was stable and low before 2009,but gradually increased from 2010(x2=30.327,P＜0.01).HIV infection rates of unfixed voluntary blood donors group was the highest (50.1 per 100 000),then HIV infection rates of primary voluntary blood donors group was the second highest (42.8 per 100 000) among these three group.But,there was no statistical difference between them (x2 =0.67,P＞ 0.05).HIV infection rate of regular voluntary blood donors group was significantly lower than unfixed blood donors group or primary blood donors group(x2 =25.69,23.38,P ＜0.01).Conclusions Under the new HIV infection situation of Shenzhen blood donors,that it has not been ensured blood safety by increasing the number of regular voluntary blood donors.Many methods should be accepted for blood safety,for example,using nucleic acid test (NAT) with high sensitivity,strengthening health education of donors,attaching importance to health assessment and recruitment of collective blood donors.