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肾移植后乙肝病毒血清学标志物的变化

Changes in serological markers of hepatitis B virus after renal transplantation.

作者信息

Urbini Dos Santos C, Sevá-Pereira T, Alves-Filho G, Lorena S L S, Soares E C, Mazzali M

机构信息

Division of Nephrology, Department of Medicine, FCM, State University of Campinas (UNICAMP), São Paulo, Brazil.

出版信息

Transplant Proc. 2008 Apr;40(3):749-51. doi: 10.1016/j.transproceed.2008.02.066.

Abstract

An estimated 350 million persons worldwide are chronically infected with hepatitis B virus (HBV). Immunosuppression after renal transplantation seems to enhance viral replication and increase the risk of developing cirrhosis and hepatocellular carcinoma. This retrospective study was performed to assess the prevalence among and serological status of HBV infection after renal transplantation at a single university Brazilian center. Thirty six (4.2%) patients among 850 kidney recipients showed positive HBsAg for more than 6 months; 31 were hepatitis B surface antigen (HBsAg) positive at transplantation. Of the 15 hepatitis B e antigen (HbeAg) positive patients, six had spontaneous HBeAg seroconversion and three also had HBsAg clearance. An additional two showed HBeAg clearance with Lamivudine without seroconversion. Among 15 HBeAg-negative patients, three developed HBeAg reversion with no elevation of alanine transferase (ALT) levels and one had HBsAg clearance. Only one patient had acute exacerbation of hepatitis B (ALT > 20 times normal range) but remained HbeAg negative. During follow-up, five patients became HBsAg positive; two reactivations of resolved hepatitis B, two with previous anti-HBS induced by vaccination, and one with no serological marker for HBV. Lamivudine was prescribed for 16 patients, two of whom had HbeAg clearance without seroconversion and five who developed viral resistance to Lamivudine after a mean of 29.2 months. No hepatocellular carcinoma or deaths related to hepatitis B were seen in this group. In summary, prevalence of HBV in kidney transplant patients was 4.2%. Immunosuppression after renal transplantation in HBV infection led to an increased risk of liver complications and changes in HBV serological status.

摘要

据估计,全球有3.5亿人长期感染乙型肝炎病毒(HBV)。肾移植后的免疫抑制似乎会增强病毒复制,并增加发生肝硬化和肝细胞癌的风险。本回顾性研究旨在评估巴西一所大学中心肾移植后HBV感染的患病率及血清学状态。850例肾移植受者中,36例(4.2%)患者的HBsAg阳性超过6个月;31例在移植时乙肝表面抗原(HBsAg)呈阳性。在15例乙肝e抗原(HBeAg)阳性的患者中,6例出现HBeAg自然血清学转换,3例同时出现HBsAg清除。另外2例在使用拉米夫定后出现HBeAg清除,但未发生血清学转换。在15例HBeAg阴性的患者中,3例出现HBeAg血清学逆转,丙氨酸转氨酶(ALT)水平未升高,1例出现HBsAg清除。只有1例患者发生乙型肝炎急性加重(ALT>正常范围的20倍),但HBeAg仍为阴性。在随访期间,5例患者HBsAg转为阳性;2例为已治愈的乙型肝炎复发,2例既往因接种疫苗产生抗-HBs,1例无HBV血清学标志物。16例患者使用了拉米夫定,其中2例在未发生血清学转换的情况下出现HBeAg清除,5例在平均29.2个月后出现对拉米夫定的病毒耐药。该组未出现肝细胞癌或与乙型肝炎相关的死亡病例。总之,肾移植患者中HBV的患病率为4.2%。肾移植后的免疫抑制在HBV感染中导致肝脏并发症风险增加及HBV血清学状态改变。

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