Molino C, Fabbian F, Cozzolino M, Longhini C
Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy.
Int J Artif Organs. 2008 Aug;31(8):683-96. doi: 10.1177/039139880803100802.
Chronic kidney disease (CKD) patients in dialysis (HD) show peculiar, atypical features of clinical presentation and diseases (cardiovascular, metabolic, hematologic). This is also true for viral hepatitis infections, for which CKD patients represent an important risk group. In the past, hepatitis B virus (HBV) was the major cause of viral hepatitis in end-stage renal disease (ESRD). However, the introduction of a rigorous infection-control strategy, routine screening of patients and staff for hepatitis B serologic markers, vaccination of susceptible patients and staff, use of separate rooms and dedicated machines for HD of HbsAg-positive patients have all led to a decline in the spread of HBV infection in dialysis. Despite the prevalence of the antibody-hepatitis C virus (HCV), there has been a marked decrease in HD patients; after the introduction of routine screening for HCV and the use of erythropoietin, its occurrence ranges from 5% to 25% in the United States, with a prevalence of 6.8% in Europe. In CKD and in HD patients, the presence of HBV and HCV is an independent and significant risk factor for death and this risk may be at least partially attributed to chronic liver disease with its attendant complications. Liver disease can progress with modest hepatic inflammation and prominent fibrosis; the natural history of viral hepatitis in these patients is dependent on the immune dysfunction typical of kidney disease. Despite recent advances in antiviral therapy, there are still many uncertainties in regards to the efficacy and long-term outcomes of treatment with antiviral agents.
接受透析治疗（HD）的慢性肾脏病（CKD）患者表现出特殊、非典型的临床表现及疾病特征（心血管、代谢、血液学方面）。病毒性肝炎感染情况亦是如此，CKD患者是此类感染的重要风险群体。过去，乙型肝炎病毒（HBV）是终末期肾病（ESRD）患者病毒性肝炎的主要病因。然而，实施严格的感染控制策略、对患者和工作人员进行乙型肝炎血清学标志物的常规筛查、对易感患者和工作人员进行疫苗接种、为HBsAg阳性患者的透析治疗使用单独房间及专用机器，所有这些措施都使透析过程中HBV感染的传播有所减少。尽管丙型肝炎病毒（HCV）抗体普遍存在，但HD患者中的感染率已显著下降；在美国，实施HCV常规筛查及使用促红细胞生成素后，其感染率在5%至25%之间，欧洲的患病率为6.8%。在CKD患者及HD患者中，HBV和HCV的存在是死亡的独立且重要的危险因素，这种风险可能至少部分归因于慢性肝病及其伴随的并发症。肝脏疾病可在轻微肝脏炎症和显著纤维化的情况下进展；这些患者中病毒性肝炎的自然病程取决于肾病典型的免疫功能障碍。尽管抗病毒治疗近期取得了进展，但抗病毒药物治疗的疗效及长期预后仍存在诸多不确定性。
