Rostaing L, Izopet J, Arnaud C, Rumeau J L, Duffaut M, Cisterne J M, Durand D
Service de néphrologie, Centre hospitalier régional de Toulouse.
Nephrologie. 1999;20(3):165-70.
The objectives of this retrospective study were to determine the prevalence of hepatitis G virus (HGV) infection in hepatitis C virus positive (HCV+ve) renal transplant (RT) patients and to evaluate the impact of HGV both on liver function tests, liver histology tests and renal parameters such as the prevalence of acute rejection and renal function. Seventy-one HCV+ve renal transplant patients with a functioning graft for whom a post renal transplant liver biopsy was available, were included. Serum HGV RNA was assessed by reverse transcription polymerase chain reaction before, at the time of, and after renal transplantation. A total of 21 (30%) of the HCV+ve RT patients had a positive HGV RNA (Group 1); seventeen of these patients (81%) were already HGV RNA+ve when the most recent renal transplantation was performed. The other 4 patients became HGV RNA+ve following renal transplantation. The mean duration of HGV infection was at least 119 +/- 64 months (18-240). Patients in group 1 did not statistically differ from the 50 HGV RNA-ve/HCV+ve RT patients (Group 2) according to sex ratio; time on dialysis; number of blood transfusions; HLA matching; the duration of HCV infection; duration and type of immunosuppression or levels of liver enzymes i.e. aspartate aminotransferase, alanine aminotransferase and gamma glutamyl transpeptidase; serum HCV RNA concentration; or frequency of genotype 1b. However, Group 1 patients were statistically younger (41 +/- 10 y compared to 47 +/- 10 y; p = 0.016) than Group 2 patients. 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 of Group 1 had overt cirrhosis. Conversely, the extent of hepatic inflammation and hepatocellular necrosis 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 (76.2%) than in Group 2 (46%; p = 0.02), although the difference was no longer significant in the multivariate analysis. In conclusion, this study shows that: i) HGV infection was often present when the patients seroconverted for HCV; ii) HGV RNA+ve/HCV+ve RT patients experience acute rejection more frequently than HGV RNA-ve/HCV+ve RT patients; iii) HGV infection seems to have no detrimental effect upon liver enzymes or liver histology in HCV+ve RT patients.
这项回顾性研究的目的是确定丙型肝炎病毒阳性（HCV+ve）肾移植（RT）患者中庚型肝炎病毒（HGV）感染的患病率，并评估HGV对肝功能检查、肝脏组织学检查以及诸如急性排斥反应患病率和肾功能等肾脏参数的影响。纳入了71例HCV+ve肾移植患者，这些患者的移植肾功能正常且有肾移植后的肝脏活检结果。在肾移植前、肾移植时和肾移植后，通过逆转录聚合酶链反应评估血清HGV RNA。共有21例（30%）HCV+ve RT患者的HGV RNA呈阳性（第1组）；其中17例患者（81%）在最近一次肾移植时HGV RNA就已经呈阳性。另外4例患者在肾移植后HGV RNA转为阳性。HGV感染的平均持续时间至少为119±64个月（18 - 240个月）。根据性别比例、透析时间、输血次数、HLA配型、HCV感染持续时间、免疫抑制的持续时间和类型或肝酶（即天冬氨酸转氨酶、丙氨酸转氨酶和γ-谷氨酰转肽酶）水平、血清HCV RNA浓度或1b基因型频率，第1组患者与50例HGV RNA阴性/HCV+ve RT患者（第2组）无统计学差异。然而，第1组患者在统计学上比第2组患者年轻（41±10岁对比47±10岁；p = 0.016）。肝脏组织学显示，第1组的纤维化程度（0.4±0.5）明显低于第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坏死的程度无统计学差异。经历至少一次急性排斥反应发作的患者数量在第1组（76.2%）明显高于第2组（46%；p = 0.02），尽管在多变量分析中这种差异不再显著。总之，本研究表明：i）患者HCV血清学转换时HGV感染通常已经存在；ii）HGV RNA阳性/HCV+ve RT患者比HGV RNA阴性/HCV+ve RT患者更频繁地经历急性排斥反应；iii）HGV感染似乎对HCV+ve RT患者的肝酶或肝脏组织学没有有害影响。
