Fabrizi F, Mangano S, Alongi G, Bisegna S, Finazzi S, Lunghi G, Ponticelli C
Division of Nephrology, Dialysis and Transplantation, Maggiore Hospital, IRCCS, Milano, Italy.
Int J Artif Organs. 2003 Dec;26(12):1048-55. doi: 10.1177/039139880302601202.
The control of the spread of hepatitis B virus (HBV) infection within dialysis units has been one of the major advances in the management of patients with end-stage renal disease (ESRD). However, clinical and biochemical expression of HBV in dialysis patients have not been adequately addressed. Elevated values of serum aminotransferase activity are a sensitive measure of hepatocellular injury, but the role of HBV infection in the development of liver disease among dialysis patients has not been adequately analysed. Also, the clinical impact related to the virological characteristics of HBV in dialysis has not been evaluated.
Demographic, biochemical and virological data from 727 patients undergoing chronic dialysis in seven dialysis units in northern Italy were collected in order to assess the biochemical consequences related to the presence of HBV infection in this population. We have measured by RT-PCR technology the titers of HBV viremia in HBsAg positive patients receiving dialysis.
Univariate analysis showed that AST and ALT values were significantly higher in HBsAg positive/HBV DNA positive than HBsAg negative patients on dialysis; AST, 22.86+/-31.34 vs. 14.19+/-9.7 IU/L (P=0.00001); and ALT, 25.07+/-41.59 vs. 13.9+/-41.59 IU/L (P=0.00001). In the subgroup of HBsAg positive patients, the frequency of detectable HBeAg in serum was 14.9% (7/47). The median value of HBV DNA in patients with detectable HBV DNA in serum was 2.160 x 10(3) copies/mL (range, 2.5 x 10(2)-4 x 10(6) copies/mL). HBsAg positive/HCV positive patients had higher aminotransferase activity than other subgroups (P=0.0001). Multivariate analysis showed a significant and independent association between detectable HBsAg/HBV DNA in serum and AST (P=0.00001) and ALT (P=0.0001) activity AST and ALT levels were lower in dialysis than healthy individuals--this finding persisted in age- and gender-matched comparisons.
The HBV viral load in HBsAg positive patients receiving maintenance dialysis is not high. HBsAg positivity with detectable HBV DNA in serum is a strong and independent predictor of raised aminotransferase activity among dialysis patients. HBsAg positive patients had greater aminotransferase activity than HBsAg negative individuals even if both the groups had mean aminotransferase levels within the normal range considered for healthy population. Clinical trials aimed at identifying the best cut-off value to enhance the diagnostic yield of AST/ALT for detecting HBV in dialysis population are under way.
控制乙型肝炎病毒（HBV）在透析单位内的传播一直是终末期肾病（ESRD）患者管理方面的一项重大进展。然而，HBV在透析患者中的临床和生化表现尚未得到充分研究。血清氨基转移酶活性升高是肝细胞损伤的敏感指标，但HBV感染在透析患者肝病发生中的作用尚未得到充分分析。此外，HBV病毒学特征在透析中的临床影响也未得到评估。
收集了意大利北部七个透析单位727例接受慢性透析患者的人口统计学、生化和病毒学数据，以评估该人群中HBV感染相关的生化后果。我们采用逆转录聚合酶链反应（RT-PCR）技术检测了接受透析的HBsAg阳性患者的HBV病毒血症滴度。
单因素分析显示，透析患者中HBsAg阳性/HBV DNA阳性者的AST和ALT值显著高于HBsAg阴性者；AST，22.86±31.34对14.19±9.7 IU/L（P = 0.00001）；ALT，25.07±41.59对13.9±41.59 IU/L（P = 0.00001）。在HBsAg阳性患者亚组中，血清中可检测到HBeAg的频率为14.9%（7/47）。血清中可检测到HBV DNA的患者中HBV DNA的中位数为2.160×10³拷贝/mL（范围，2.5×10² - 4×10⁶拷贝/mL）。HBsAg阳性/HCV阳性患者的氨基转移酶活性高于其他亚组（P = 0.0001）。多因素分析显示，血清中可检测到的HBsAg/HBV DNA与AST（P = 0.00001）和ALT（P = 0.0001）活性之间存在显著且独立的关联。透析患者的AST和ALT水平低于健康个体——这一发现在校正年龄和性别匹配的比较中仍然存在。
接受维持性透析的HBsAg阳性患者的HBV病毒载量不高。血清中HBsAg阳性且可检测到HBV DNA是透析患者氨基转移酶活性升高的一个强大且独立的预测指标。即使两组的平均氨基转移酶水平都在健康人群正常范围内，HBsAg阳性患者的氨基转移酶活性仍高于HBsAg阴性个体。旨在确定最佳临界值以提高AST/ALT在透析人群中检测HBV诊断率的临床试验正在进行中。
