Sterling R K, Sanyal A J, Luketic V A, Stravitz R T, King A L, Post A B, Mills A S, Contos M J, Shiffman M L
Department of Pathology, Medical College of Virginia Commonwealth University, Richmond 23298, USA.
Am J Gastroenterol. 1999 Dec;94(12):3576-82. doi: 10.1111/j.1572-0241.1999.01649.x.
Hepatitis C virus (HCV) is common in patients with end stage renal disease (ESRD) awaiting renal transplantation (RT). However, few data are available on the liver histology and viral titer in these patients relative to patients with HCV and normal renal function. The aims of this study were to assess liver histology, quantitative HCV-RNA titer, and alanine aminotransferase (ALT) levels in patients with ESRD awaiting RT, and to identify clinical predictors of histological progression to advanced bridging fibrosis and/or cirrhosis.
A total of 50 consecutive patients (mean age 42 yr, 62% male) with ESRD and HCV, who were awaiting RT, underwent liver biopsy. Two HCV populations, one with persistently normal ALT and another with elevated ALT, both with normal renal function, served as controls. HCV-RNA titer was assessed by quantitative PCR.
Of the patients with ESRD, 94% had normal ALT. Log HCV RNA titer was significantly higher in patients with ESRD (5.8+/-0.3) than in either normal ALT (5.4+/-0.1) or elevated ALT (5.3+/-0.1) controls (p < 0.05). Knodell Histological Activity Index (HAI) in patients with ESRD was similar to that observed in control patients with normal ALT (4.8+/-0.4 vs 4.9+/-0.4) but significantly less (p < 0.05) than that observed in control patients with elevated ALT (8.4+/-0.5). The percentage of patients with bridging fibrosis or cirrhosis was similar in patients with ESRD and controls with persistently normal ALT (22% vs 13%) but significantly less (p < 0.001) than that observed in control patients with elevated ALT (48%). No significant differences in ALT, HCV-RNA titer, duration on hemodialysis, or time from first possible exposure was observed between ESRD patients with advance fibrosis (n = 11) and those with mild disease (n = 39).
Our data suggest that liver biopsy is necessary to exclude significant liver pathology in patients with HCV and ESRD, and to help define those patients in whom interferon treatment might be helpful.
丙型肝炎病毒（HCV）在等待肾移植（RT）的终末期肾病（ESRD）患者中很常见。然而，相对于肾功能正常的HCV患者，关于这些患者的肝脏组织学和病毒滴度的数据很少。本研究的目的是评估等待RT的ESRD患者的肝脏组织学、HCV-RNA定量滴度和丙氨酸转氨酶（ALT）水平，并确定组织学进展为晚期桥接纤维化和/或肝硬化的临床预测因素。
共有50例连续的等待RT的ESRD合并HCV患者（平均年龄42岁，62%为男性）接受了肝活检。两个HCV人群，一个ALT持续正常，另一个ALT升高，且肾功能均正常，作为对照。通过定量PCR评估HCV-RNA滴度。
ESRD患者中，94%的患者ALT正常。ESRD患者的log HCV RNA滴度（5.8±0.3）显著高于ALT正常（5.4±0.1）或ALT升高（5.3±0.1）的对照组（p<0.05）。ESRD患者的Knodell组织学活动指数（HAI）与ALT正常的对照患者相似（4.8±0.4对4.9±0.4），但显著低于ALT升高的对照患者（8.4±0.5）（p<0.05）。ESRD患者和ALT持续正常的对照患者中桥接纤维化或肝硬化患者的百分比相似（22%对13%），但显著低于ALT升高的对照患者（48%）（p<0.001）。进展性纤维化的ESRD患者（n=11）和轻度疾病患者（n=39）在ALT、HCV-RNA滴度、血液透析持续时间或首次可能接触时间方面未观察到显著差异。
我们的数据表明，肝活检对于排除HCV和ESRD患者的严重肝脏病变以及帮助确定可能从干扰素治疗中获益的患者是必要的。
