Division of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil.
Eur J Gastroenterol Hepatol. 2009 Dec;21(12):1395-9. doi: 10.1097/MEG.0b013e328313bbc1.
Few studies have evaluated the histological aspects of hepatitis C virus (HCV) infection in hemodialysis patients and the factors related to the progression of hepatic fibrosis in this population have not been defined.
To evaluate the influence of host-related factors on the fibrosis progression in end-stage renal disease (ESRD) patients with HCV infection.
HCV-infected ESRD patients who submitted to liver biopsy were included. The fibrosis stages were classified according to METAVIR scoring system. For the identification of factors associated with more advanced liver fibrosis, the patients were classified into two groups: group 1, absence of septal fibrosis (F0-1) and group 2, presence of septal fibrosis (F2-4). Groups 1 and 2 were compared regarding demographic, epidemiological, and laboratory variables and logistic regression analysis was used to identify the variables that were independently associated with the presence of septal fibrosis.
A total of 216 ESRD patients (63% men, 44+/-11 years) were included. In the histological analysis, the fibrosis stages were as follows: F0=36%, F1=41%, F2=12%, F3=7, and 4% had cirrhosis (F4). In the logistic regression model, the variables that were independently associated with the presence of septal fibrosis were duration of infection, estimated age at infection, coinfection with HBV and aspartate aminotransferase levels.
These findings support the importance of obtaining an adequate immune response to HBV vaccination and careful monitoring of liver disease in patients who become infected at an advanced age and/or those presenting elevated aspartate aminotransferase levels, as these are the main factors associated with the presence of septal fibrosis in ESRD patients.
很少有研究评估丙型肝炎病毒（HCV）感染在血液透析患者中的组织学方面，也没有确定该人群中与肝纤维化进展相关的因素。
评估宿主相关因素对 HCV 感染终末期肾病（ESRD）患者纤维化进展的影响。
纳入接受肝活检的 HCV 感染 ESRD 患者。纤维化分期根据 METAVIR 评分系统进行分类。为了确定与更严重肝纤维化相关的因素，将患者分为两组：第 1 组，无间隔纤维化（F0-1）；第 2 组，有间隔纤维化（F2-4）。比较两组之间的人口统计学、流行病学和实验室变量，并进行逻辑回归分析，以确定与间隔纤维化存在相关的变量。
共纳入 216 例 ESRD 患者（63%为男性，44+/-11 岁）。组织学分析显示，纤维化分期如下：F0=36%，F1=41%，F2=12%，F3=7%，4%为肝硬化（F4）。在逻辑回归模型中，与间隔纤维化存在相关的独立变量包括感染持续时间、感染时估计年龄、乙型肝炎病毒合并感染和天冬氨酸氨基转移酶水平。
这些发现支持在感染年龄较大和/或天门冬氨酸氨基转移酶水平升高的患者中获得对乙型肝炎疫苗的充分免疫反应以及对肝病进行仔细监测的重要性，因为这些是与 ESRD 患者间隔纤维化存在相关的主要因素。
