Sikole Aleksandar, Dzekova P, Asani A, Amitov V, Selim Gj, Gelev S, Polenakovic Momir
University Clinic of Nephrology, Skopje, R. Macedonia.
Prilozi. 2008 Dec;29(2):155-64.
Patients with renal disease are at increased risk of acquiring hepatitis C virus (HCV) infection because of their frequent exposure to blood from transfusions or exposure to HCV-contaminated medical equipment during hemodialysis. The prevalence of anti-HCV antibodies among hemodialysis patients varies between 5-10% in the developed world, and 10-70% in developing countries. Acute hepatitis C is often mild and associated with few, if any symptoms. The major complication of acute HCV infection is chronic hepatitis, which occurs in up to 80% of the cases, the long-term outcome being cirrhosis, portal hypertension, hepatic failure, and hepatocellular carcinoma. Interferon alpha (IFN-alpha) has shown activity against HCV. Twenty four to 48 week course of therapy with interferon could lead to a sustained loss of HCV RNA, normalization of alanine aminotrasferase (ALT) levels, and resolution of the liver disease. Sustained viral response was achieved in approximately half of the treated patients. Therapy with interferon was associated with a number of adverse events such as: "flu-like" symptoms, neurological, gastrointestinal symptoms, anemia, fatigue, thrombocytopenia, leucopenia. A major advance in therapy came with the addition of ribavirin to interferon therapy. Peginterferon-alpha-2a (40KD) is a new 'pegylated' subcutaneous formulation of interferon-alpha-2a, that was developed to improve the pharmacokinetic profile and therapeutic efficacy of interferon-alpha-2a. In our study, fourteen hemodialysis patients with chronic hepatitis C received 135 microg PEG-IFN alpha-2a subcutaneously, once a week, after dialysis session for a period of 48 weeks. In the intention-to-treat analysis, sustained viral response was present in 36% of the patients (five out of fourteen patients) at the end of the follow up period. The biochemical response with normalization of serum ALT levels during the treatment was observed in all treated patients (83 +/- 20.1 U/L at base line vs. 23.4 +/- 4.6 U/L after the 48 weeks; p < 0.01). At present, therapy for hepatitis C should be considered in hemodialysis patients with significant liver disease, minimal other co morbidities, and a reasonable likelihood of prolonged survival or if renal transplantation is planned.
肾病患者感染丙型肝炎病毒（HCV）的风险增加，因为他们经常输血接触血液，或在血液透析期间接触受HCV污染的医疗设备。在发达国家，血液透析患者中抗-HCV抗体的流行率在5%-10%之间，而在发展中国家则为10%-70%。急性丙型肝炎通常症状轻微，即使有症状也很少。急性HCV感染的主要并发症是慢性肝炎，高达80%的病例会发生慢性肝炎，其长期后果是肝硬化、门静脉高压、肝衰竭和肝细胞癌。α干扰素（IFN-α）已显示出对HCV有活性。用干扰素进行24至48周的疗程治疗可导致HCV RNA持续消失、丙氨酸转氨酶（ALT）水平正常化以及肝病消退。约一半的接受治疗患者实现了持续病毒学应答。干扰素治疗会伴随一些不良事件，如：“流感样”症状、神经症状、胃肠道症状、贫血、疲劳、血小板减少、白细胞减少。治疗方面的一项重大进展是在干扰素治疗中加入了利巴韦林。聚乙二醇化干扰素α-2a（40KD）是一种新的“聚乙二醇化”皮下注射用α-2a干扰素制剂，其研发目的是改善α-2a干扰素的药代动力学特征和治疗效果。在我们的研究中，14例慢性丙型肝炎血液透析患者在每次透析结束后皮下注射135微克聚乙二醇化干扰素α-2a，每周一次，为期48周。在意向性分析中，随访期末36%的患者（14例患者中的5例）出现了持续病毒学应答。所有接受治疗的患者在治疗期间均观察到血清ALT水平正常化的生化应答（基线时为83±20.1 U/L，48周后为23.4±4.6 U/L；p<0.01）。目前，对于有明显肝病、其他合并症最少、有延长生存期合理可能性或计划进行肾移植的血液透析患者，应考虑进行丙型肝炎治疗。
