Matos Carla A L, Perez Renata M, Lemos Lara B, Medina-Pestana José O, Lanzoni Valeria P, Alberto Fernando L, Moreira Eloísa S, Silva Antonio Eduardo B, Ferraz Maria Lucia G
Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Eur J Gastroenterol Hepatol. 2007 Aug;19(8):653-7. doi: 10.1097/MEG.0b013e328133f091.
Hepatitis B may show a more aggressive course after kidney transplantation, but the factors associated with the progression of fibrosis in this group have not been identified.
To determine the influence of hepatitis B virus (HBV) viral load and host-related factors on the progression of hepatic fibrosis in hepatitis B virus-infected renal transplant recipients.
Renal transplant patients positive for HBV surface antigen (HBsAg) and submitted to a liver biopsy because of evidence of viral replication were included. Patients with advanced fibrosis (METAVIR F3-F4) were compared with patients with mild fibrosis (F0-F2) regarding sex, age, estimated time since infection, post-transplant time, donor type, history of renal transplantation, alanine aminotransferase, anti-hepatitis C virus, HBeAg and quantitative hepatitis B virus-DNA. Logistic regression analysis was applied to identify variables independently associated with more advanced fibrosis.
Fifty-five patients (75% men, 41+/-11 years) with a mean post-transplant time of 5+/-4 years were included. HBeAg was detected in 67% of the patients and anti-hepatitis C virus in 35%. The median hepatitis B virus-DNA level was 2.8 x 10(8) copies/ml. Seventeen (31%) patients had advanced fibrosis. Using logistic regression analysis, the only variable that showed an independent association with more advanced stages of fibrosis was post-transplant time (P=0.03, odds ratio: 1.2, 95% confidence interval: 1.02-1.45).
Hepatitis B virus viral load, although very high, and hepatitis B virus/hepatitis C virus coinfection are not related to the intensity of liver fibrosis in renal transplant patients infected with hepatitis B virus. Post-transplant time was the only factor independently associated with more advanced liver fibrosis, suggesting the influence of immunosuppression on the progression of liver disease in these patients.
肾移植后乙型肝炎可能呈现更具侵袭性的病程，但该组中与纤维化进展相关的因素尚未明确。
确定乙肝病毒（HBV）病毒载量及宿主相关因素对感染乙肝病毒的肾移植受者肝纤维化进展的影响。
纳入乙肝表面抗原（HBsAg）阳性且因病毒复制证据接受肝活检的肾移植患者。将晚期纤维化（METAVIR F3 - F4）患者与轻度纤维化（F0 - F2）患者在性别、年龄、估计感染时间、移植后时间、供体类型、肾移植病史、丙氨酸氨基转移酶、抗丙型肝炎病毒、HBeAg及乙肝病毒定量DNA方面进行比较。应用逻辑回归分析确定与更晚期纤维化独立相关的变量。
纳入55例患者（75%为男性，年龄41±11岁），移植后平均时间为5±4年。67%的患者检测到HBeAg，35%的患者检测到抗丙型肝炎病毒。乙肝病毒DNA水平中位数为2.8×10⁸拷贝/ml。17例（31%）患者有晚期纤维化。通过逻辑回归分析，唯一显示与更晚期纤维化独立相关的变量是移植后时间（P = 0.03，比值比：1.2，95%置信区间：1.02 - 1.45）。
乙肝病毒载量虽很高，但乙肝病毒/丙型肝炎病毒合并感染与感染乙肝病毒的肾移植患者肝纤维化程度无关。移植后时间是与更晚期肝纤维化独立相关的唯一因素，提示免疫抑制对这些患者肝病进展有影响。
Zotero 插件