Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
J Gastroenterol. 2010 Mar;45(3):326-34. doi: 10.1007/s00535-009-0149-0. Epub 2009 Nov 5.
The natural history of hepatitis C virus (HCV) carriers and the effect of ursodeoxycholic acid (UDCA) have not been fully elucidated among hemodialysis (HD) patients.
Eighty-four anti-HCV antibody- and HCV RNA-positive and 154 anti-HCV antibody-negative HD patients who were retrospectively observed for at least 3 years were analyzed. We investigated the factors associated with thrombocytopenia (< 1.3 x 10(5)/microL) and decreased platelet count (PLT) (more than 20% decrease during the follow-up period), which were considered to be indicators of hepatic fibrosis. In addition, another 16 HD patients with HCV who received 300 mg/day UDCA orally for at least 6 months were investigated. Changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT) and PLT were assessed.
After the 60.3-months mean follow-up period, HCV infection was independently associated with both thrombocytopenia [odds ratio (OR) 2.589] and decreased PLT (OR 2.339) in 238 HD patients. In 84 HD patients with HCV, the average ALT levels (> or = 15 IU/L) during the follow-up period was associated with thrombocytopenia (OR 3.882) and decreased PLT (OR 4.470). In addition, ALT, AST and GGT significantly decreased at 6 months after starting UDCA, but PLT did not change in 16 HD patients with HCV.
These results indicate that HCV infection is a risk for thrombocytopenia which should be associated with hepatic fibrosis in HD patients. In addition, the clinical course of ALT levels predicts the progression of thrombocytopenia, and UDCA may effectively lower ALT levels in HD patients with HCV.
尚未充分阐明丙型肝炎病毒（HCV）携带者的自然史以及熊去氧胆酸（UDCA）的作用。
对 84 例抗 HCV 抗体和 HCV RNA 阳性及 154 例抗 HCV 抗体阴性的接受血液透析（HD）治疗的患者进行回顾性观察至少 3 年。我们分析了与血小板减少症（<1.3×105/μL）和血小板计数降低（随访期间降低超过 20%）相关的因素，这些因素被认为是肝纤维化的指标。此外，还对另外 16 例接受 300mg/天 UDCA 口服治疗至少 6 个月的 HCV 阳性 HD 患者进行了研究。评估了丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转肽酶（GGT）和血小板的变化。
在 60.3 个月的平均随访后，HCV 感染与 238 例 HD 患者的血小板减少症（比值比[OR] 2.589）和血小板计数降低（OR 2.339）独立相关。在 84 例 HCV 阳性的 HD 患者中，随访期间平均 ALT 水平（≥15IU/L）与血小板减少症（OR 3.882）和血小板计数降低（OR 4.470）相关。此外，在 16 例 HCV 阳性的 HD 患者中，UDCA 治疗后 6 个月时 ALT、AST 和 GGT 显著降低，但血小板计数无变化。
这些结果表明，HCV 感染是血小板减少症的危险因素，这与 HD 患者的肝纤维化有关。此外，ALT 水平的临床过程预测血小板减少症的进展，UDCA 可能有效降低 HCV 阳性 HD 患者的 ALT 水平。
