Internal Medicine and Gastroenterology, Hospital Sultanah Bahiyah, KM6, Jalan Langgar, Alor Star 05460, Malaysia.
Singapore Med J. 2011 Feb;52(2):86-9.
This study was conducted to compare the genotype and markers of disease severity of chronic hepatitis C (CHC), namely viral load, alanine transaminase (ALT) levels and histopathological findings on liver biopsy, in patients with and without end-stage renal disease (ESRD).
This was a cross-sectional retrospective comparative study that included ESRD patients on haemodialysis and non-ESRD patients with CHC who underwent liver biopsy between January 2004 and December 2006. Blood tests for viral load (VL) (hepatitis C virus, ribonucleic acid, polymerase chain reaction), genotyping and ALT were administered. VL was grouped into low (less than 5 log10) and high (more than or equal to 5 log10) VL, genotype into G1 and 2, 3, 4, and ALT into normal and elevated ALT. Necroinflammatory activity was grouped into mild (G0-6) and moderate/severe (G7-18) activity, and fibrosis into mild (S0-2) and moderate/severe (S3-6) fibrosis. These variables were compared between the two groups.
Genotype 1 was significantly higher in ESRD patients than in non-ESRD patients, in whom genotypes 2, 3 and 4 were higher. Although the proportion of patients with high VL was greater and the duration of CHC was longer in the ESRD group, the ALT levels were lower and the histopathological grading of necroinflammatory activity and stages of fibrosis were less severe in ESRD compared to non-ESRD patients.
The lower levels of ALT observed in CHC patients with ESRD translate to histopathological benefits.
本研究旨在比较慢性丙型肝炎（CHC）患者（包括终末期肾病（ESRD）患者和非 ESRD 患者）的基因型和疾病严重程度标志物，即病毒载量、丙氨酸转氨酶（ALT）水平和肝活检的组织病理学发现。
这是一项回顾性的横断面研究，纳入了 2004 年 1 月至 2006 年 12 月期间接受肝活检的 ESRD 患者和非 ESRD 患者。进行了病毒载量（VL）（丙型肝炎病毒，核糖核酸，聚合酶链反应）、基因分型和 ALT 的血液检测。将 VL 分为低（<5 log10）和高（≥5 log10）VL，基因型分为 G1 和 2、3、4，ALT 分为正常和升高的 ALT。坏死性炎症活动分为轻度（G0-6）和中重度（G7-18），纤维化分为轻度（S0-2）和中重度（S3-6）。比较两组之间的这些变量。
ESRD 患者的基因型 1显著高于非 ESRD 患者，而非 ESRD 患者的基因型 2、3 和 4更高。尽管 ESRD 组的高 VL 比例较大且 CHC 持续时间较长，但与非 ESRD 患者相比，ESRD 患者的 ALT 水平较低，坏死性炎症活动的组织病理学分级和纤维化分期较轻。
ESRD 患者的 CHC 中较低的 ALT 水平转化为组织病理学获益。
