Fabrizi Fabrizio, Lunghi Giovanna, Alongi Giancarlo, Bisegna Sergio, Campolo Gesualdo, Mangano Stefano, Limido Aurelio, Pagliari Bruno, Tettamanzi Fabio, Ponticelli Claudio
Nephrology and Dialysis Division, Institute of Hygiene and Preventive Medicine, Maggiore Hospital, IRCCS, Milano, Italy.
Am J Kidney Dis. 2003 Jun;41(6):1278-85. doi: 10.1016/s0272-6386(03)00360-3.
Control of the spread of hepatitis B virus (HBV) infection in dialysis units has been one of major advances in the management of end-stage renal disease. However, the natural history of HBV in dialysis patients remains unclear. The aim of this study is to measure monthly HBV viral load (HBV DNA) in a large cohort (n = 29) of hepatitis B surface antigen (HBsAg)-positive chronic dialysis patients during 12 months.
HBV DNA was measured using the Amplicor HBV Monitor Test (Roche Diagnostics, Branchburg, NJ), an in vitro assay using polymerase chain reaction nucleic acid amplification and DNA hybridization for the quantitative measurement of HBV DNA in serum.
We observed three HBV DNA patterns: (1) patients persistently positive by Amplicor HBV Monitor Test (persistent HBV DNA; 7 of 29 patients; 24.1%), (2) individuals with alternatively positive and negative results (intermittent HBV DNA; 18 of 29 patients; 62.1%), and (3) patients persistently negative by Amplicor HBV Monitor Test (4 of 29 patients; 13.8%). HBV viral load was greater in patients with persistent compared with intermittent HBV DNA (persistently HBV DNA positive; 2.686 x 10(4) copies/mL; 95% confidence interval [CI], 5.2499 x 10(4) to 1.8158 x 10(4)copies/mL) versus intermittently HBV DNA positive (1.071 x 10(3) copies/mL; 95% CI, 8.524 x 10(3) to 4.09 x 10(2) copies/mL; P = 0.0001). In the entire group, HBV load at study entry was low and did not change versus the end of follow-up.
Three patterns of HBV viremia in dialysis patients over time were assessed; HBV load was not high and was relatively stable. HBsAg-positive patients who were intermittently HBV DNA positive had less HBV viral load than persistently HBV DNA-positive patients. Periodic testing for HBV DNA to assess the virological status of HBsAg-positive dialysis patients is recommended.
控制乙型肝炎病毒（HBV）在透析单位的传播一直是终末期肾病管理的主要进展之一。然而，HBV在透析患者中的自然病程仍不清楚。本研究的目的是在12个月内对一大群（n = 29）乙型肝炎表面抗原（HBsAg）阳性的慢性透析患者每月测量HBV病毒载量（HBV DNA）。
使用Amplicor HBV Monitor Test（罗氏诊断公司，新泽西州布兰奇堡）测量HBV DNA，这是一种使用聚合酶链反应核酸扩增和DNA杂交进行血清中HBV DNA定量测量的体外检测方法。
我们观察到三种HBV DNA模式：（1）通过Amplicor HBV Monitor Test持续呈阳性的患者（持续性HBV DNA；29例患者中的7例；24.1%），（2）结果交替呈阳性和阴性的个体（间歇性HBV DNA；29例患者中的18例；62.1%），以及（3）通过Amplicor HBV Monitor Test持续呈阴性的患者（29例患者中的4例；13.8%）。持续性HBV DNA患者的HBV病毒载量高于间歇性HBV DNA患者（持续性HBV DNA阳性；2.686×10⁴拷贝/mL；95%置信区间[CI]，5.2499×10⁴至1.8158×10⁴拷贝/mL），而间歇性HBV DNA阳性患者为（1.071×10³拷贝/mL；95% CI，8.524×10³至4.09×10²拷贝/mL；P = 0.0001）。在整个组中，研究开始时的HBV载量较低，与随访结束时相比没有变化。
评估了透析患者随时间推移的三种HBV病毒血症模式；HBV载量不高且相对稳定。间歇性HBV DNA阳性的HBsAg阳性患者的HBV病毒载量低于持续性HBV DNA阳性患者。建议对HBsAg阳性的透析患者定期检测HBV DNA以评估其病毒学状态。
