Rostaing L, Izopet J, Arnaud C, Cisterne J M, Alric L, Rumeau J L, Duffaut M, Durand D
Internal Medicine Department, Toulouse University Hospital, France.
Transplantation. 1999 Feb 27;67(4):556-60. doi: 10.1097/00007890-199902270-00012.
The hepatitis G virus (HGV) has been recently cloned. Studies in immunocompetent patients have shown that HGV superinfection in hepatitis C virus (HCV)-positive patients does not affect (i) clinical presentation, HCV RNA level, or response to interferon-alpha therapy; or (ii) the histopathologic severity and characteristics of chronic hepatitis. No data are currently available on the impact of HGV infection on liver histology of renal transplant (RT) patients although the reported prevalence of serum HGV RNA in this population is high, ranging from 14% to 55%.
We determined the prevalence of HGV infection in 103 HCV-positive RT patients for whom HGV RNA was retrospectively determined by reverse transcription-polymerase chain reaction before, at the time of, and after transplantation (last follow-up). We evaluated the impact of HGV on liver function tests, liver histology (by means of the Knodell score), and renal parameters such as the prevalence of acute rejection and renal function.
A total of 29 (28%) of the HCV-positive RT patients had a positive HGV RNA (group 1). The mean duration of HGV infection was at least 119+/-64 months (range: 18-240 months). Group 1 patients were compared to the 74 HGV RNA-negative/HCV-positive RT patients (group 2). Liver histology showed a significantly lower degree of fibrosis in group 1 (0.4+/-0.5) than in group 2 (1+/-1.2; P=0.02); two patients from group 2 but none from group 1 had overt cirrhosis. Conversely, the extent of hepatic inflammation and hepatocellular destruction was not statistically different between the two groups. The number of patients who experienced at least one acute rejection episode was significantly higher in group 1 (69%) than in group 2 (42%; P=0.01). However, the multivariate analysis did not identify the presence of HGV RNA at the time of renal transplantation as an independent factor of acute rejection; conversely, (i) the occurrence of cytomegalovirus infection or disease and (ii) the duration of HCV infection significantly increased the likelihood of having acute rejection.
This study shows that: (i) HGV infection was often present when the patients seroconverted for HCV, (ii) HGV RNA-positive/HCV-positive RT patients experienced acute rejection more frequently than HGV RNA-negative/HCV-positive RT patients, and (iii) HGV infection seems to have no detrimental effect upon liver enzymes or liver histology in HCV-positive RT patients.
庚型肝炎病毒（HGV）最近已被克隆。对免疫功能正常患者的研究表明，丙型肝炎病毒（HCV）阳性患者感染HGV不会影响：（i）临床表现、HCV RNA水平或对α干扰素治疗的反应；或（ii）慢性肝炎的组织病理学严重程度和特征。目前尚无关于HGV感染对肾移植（RT）患者肝脏组织学影响的数据，尽管该人群中报告的血清HGV RNA患病率很高，在14%至55%之间。
我们测定了103例HCV阳性RT患者中HGV感染的患病率，通过逆转录聚合酶链反应对这些患者在移植前、移植时及移植后（最后一次随访）进行回顾性检测HGV RNA。我们评估了HGV对肝功能检查、肝脏组织学（采用Knodell评分）以及肾脏参数（如急性排斥反应的患病率和肾功能）的影响。
103例HCV阳性RT患者中共有29例（28%）HGV RNA呈阳性（第1组）。HGV感染的平均持续时间至少为119±64个月（范围：18 - 240个月）。将第1组患者与74例HGV RNA阴性/HCV阳性RT患者（第2组）进行比较。肝脏组织学显示，第1组的纤维化程度（0.4±0.5）显著低于第2组（1±1.2；P = 0.02）；第2组有2例患者出现明显肝硬化，而第1组无。相反，两组之间肝脏炎症和肝细胞破坏的程度无统计学差异。第1组经历至少一次急性排斥反应的患者数量（69%）显著高于第2组（42%；P = 0.01）。然而，多因素分析未将肾移植时HGV RNA的存在确定为急性排斥反应的独立因素；相反，（i）巨细胞病毒感染或疾病的发生以及（ii）HCV感染的持续时间显著增加了发生急性排斥反应的可能性。
本研究表明：（i）患者HCV血清学转换时常常存在HGV感染；（ii）HGV RNA阳性/HCV阳性RT患者比HGV RNA阴性/HCV阳性RT患者更频繁地发生急性排斥反应；（iii）HGV感染似乎对HCV阳性RT患者的肝酶或肝脏组织学没有有害影响。
