感染获得时间：肾移植患者丙型肝炎病毒相关肝病严重程度的决定因素。

The acquisition time of infection: a determinant of the severity of hepatitis C virus-related liver disease in renal transplant patients.

机构信息

Division of Nephrology, Ege University Medical School, Izmir, Turkey.

出版信息

Clin Transplant. 2009 Sep-Oct;23(5):723-31. doi: 10.1111/j.1399-0012.2009.01017.x. Epub 2009 Jun 30.

DOI:10.1111/j.1399-0012.2009.01017.x

PMID:19573091

Abstract

BACKGROUND

The aim of this study was to compare the clinical and histopathological course of HCV infection acquired before and during or after renal transplantation.

METHODS

According to HCV status, 197 RT patients were divided into three groups. At the time of RT, anti-HCV antibody was positive in 47 patients (pre-RT HCV group). In 27 patients, in whom anti-HCV negative at the time of RT, anti-HCV and/or HCV RNA was found to be positive following an ALT elevation episode after RT (post-RT HCV group). Both anti-HCV and HCV RNA were negative at all times in remaining 123 patients (control group).

RESULTS

Liver biopsy was performed in 31 of 47 patients in pre-RT and 24 of 27 in post-RT HCV group after RT. Duration of follow-up was similar in all groups with a mean of 7.1 +/- 4.0 yr. Ascites and encephalopathy were seen in only post-RT HCV group (22%). Histological grade (6.5 +/- 2.7 vs. 4.1 +/- 1.4) and stage (2.0 +/- 1.5 vs. 0.8 +/- 0.8) was significantly severe in post-RT HCV group (p < 0.01). Three patients died due to liver failure in post-RT HCV group.

CONCLUSIONS

HCV infection acquired during or after RT shows a severe and rapidly progressive clinicopathological course, which is significantly different from pre-transplant anti-HCV positive patients.

摘要

背景

本研究旨在比较肾移植前、移植时和移植后获得的 HCV 感染的临床和组织病理学过程。

方法

根据 HCV 状态，将 197 例 RT 患者分为三组。在 RT 时，47 例患者抗 HCV 抗体阳性（预 RT HCV 组）。在 27 例患者中，抗 HCV 在 RT 时为阴性，但在 RT 后 ALT 升高时发现抗 HCV 和/或 HCV RNA 阳性（后 RT HCV 组）。在其余 123 例患者中，抗 HCV 和 HCV RNA 均为阴性（对照组）。

结果

在预 RT 组的 47 例患者和后 RT HCV 组的 24 例患者中进行了肝活检。所有组的随访时间相似，平均为 7.1 +/- 4.0 年。只有在后 RT HCV 组（22%）出现腹水和肝性脑病。在后 RT HCV 组，组织学分级（6.5 +/- 2.7 对 4.1 +/- 1.4）和分期（2.0 +/- 1.5 对 0.8 +/- 0.8）显著更严重（p < 0.01）。在后 RT HCV 组，有 3 例患者因肝功能衰竭而死亡。