Furusyo N, Hayashi J, Ariyama I, Sawayama Y, Etoh Y, Shigematsu M, Kashiwagi S
Department of General Medicine, Kyushu University Hospital, Fukuoka, Japan.
Am J Gastroenterol. 2000 Feb;95(2):490-6. doi: 10.1111/j.1572-0241.2000.01773.x.
Hepatitis C virus (HCV) infection is a major complication among hemodialysis patients the world over. To determine the natural course of HCV viremic levels in patients on maintenance hemodialysis, we prospectively quantified the HCV RNA levels in serial blood samples from hemodialysis patients and compared them with those in nonuremic subjects.
The population studied included 98 hemodialysis patients and 228 nonuremic subjects with chronic HCV infection. HCV RNA was detected by polymerase chain reaction (PCR) and the levels were determined by branched DNA probe assay. HCV RNA genotypes were determined by PCR using type-specific primers.
HCV RNA levels were significantly lower in hemodialysis patients (median, 0.4x10(6) genome equivalent [Meq]/ml) than in nonuremic subjects (median, 3.0 Meq/ml) (p<0.05). HCV of genotype 1b was prevalent in the hemodialysis patients (81.6%) and nonuremic subjects (88.6%). HCV RNA levels in 20 hemodialysis patients with genotype 1b were significantly reduced after each hemodialysis procedure (p<0.05). The 3-yr prospective observation from 1995 to 1998 showed a significant decrease of HCV RNA levels in 47 hemodialysis patients with genotype 1b (median, 1.9-0.9 Meq/ml, p<0.05), whereas levels in 155 nonuremic subjects with genotype 1b did not decrease (median, 2.6-3.0 Meq/ml). There were no patients or nonuremic subjects with undetectable HCV RNA by a PCR assay during the observation period.
These observations suggest that maintenance hemodialysis decreases the HCV RNA levels in hemodialysis patients with chronic HCV infection, but does not produce clearance of the viremia.
丙型肝炎病毒（HCV）感染是全球血液透析患者的主要并发症。为了确定维持性血液透析患者HCV病毒血症水平的自然病程，我们前瞻性地对血液透析患者系列血样中的HCV RNA水平进行了定量，并将其与非尿毒症受试者的水平进行比较。
研究人群包括98例血液透析患者和228例慢性HCV感染的非尿毒症受试者。通过聚合酶链反应（PCR）检测HCV RNA，并通过分支DNA探针测定法确定其水平。使用型特异性引物通过PCR确定HCV RNA基因型。
血液透析患者的HCV RNA水平（中位数，0.4×10⁶基因组当量[Meq]/ml）显著低于非尿毒症受试者（中位数，3.0 Meq/ml）（p<0.05）。1b型HCV在血液透析患者（81.6%）和非尿毒症受试者（88.6%）中普遍存在。20例1b型血液透析患者每次血液透析后HCV RNA水平显著降低（p<0.05）。1995年至1998年的3年前瞻性观察显示，47例1b型血液透析患者的HCV RNA水平显著下降（中位数，1.9 - 0.9 Meq/ml，p<0.05），而155例1b型非尿毒症受试者的水平未下降（中位数，2.6 - 3.0 Meq/ml）。观察期间，通过PCR检测未发现HCV RNA的患者或非尿毒症受试者。
这些观察结果表明，维持性血液透析可降低慢性HCV感染的血液透析患者的HCV RNA水平，但不能清除病毒血症。
