Idrees Muhammad Khalid, Batool Salma, Ahmed Ejaz
Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
J Pak Med Assoc. 2011 Dec;61(12):1210-4.
To study the characterstics, pattern of viral markers, hepatic transaminases and other associated hepatitis virus infections among maintainence haemodialysis patients.
This prospective cross-sectional study was conducted at the dialysis unit of Sindh Institute of Urology and Transplantation Karachi on end-stage renal disease (ESRD) patients undergoing maintainence haemodialysis from November 2009 to April 2010. Patients on anti-viral drugs were excluded Blood samples were taken, immediately before start of dialysis, for Hepatitis B virus serology, anti-HCV, polymerase chain reaction (PCR) for HBV DNA and biochemical tests. Abdominal ultrasound was performed for liver, spleen, portal vein diameter and presence or absence of ascites. Data analysis was done by using SPSS 10.0. The level of significance was taken as 0.05.
Out of 1220 ESRD patients on maintainence haemodialysis at SIUT, 124 were HBsAg positive but 26 patients were excluded as they had received anti-viral therapy. Finally 98 patients including 71 (72%) males and 27 (28%) females completed the study. The mean age was 34.98 +/- 12.67 years. Most of the patients did not have hepatitis symptoms. ALT level was raised above cutoff value of 20 IU/ml in 62.2% patients while AST was raised in 75.4% patients. HBeAg was positive in 34.6%, anti-HBe antibody was positive in 65% patients and HBV DNA was detected in 65.3%. More than half of the patients had HCV co-infection. Six patients had cirrhosis. Thirty four patients were non-replicating carriers. The mean duration of dialysis and duration of HBsAg positivity were significantly longer in those patients who had hepatitis B and hepatitis C coinfection (p<0.05).
Hepatitis B virus infection in dialysis dependent patients is mostly asymptomatic. Mild transaminase elevation is frequently encountered.
研究维持性血液透析患者的特征、病毒标志物模式、肝转氨酶及其他相关肝炎病毒感染情况。
本前瞻性横断面研究于2009年11月至2010年4月在卡拉奇信德泌尿学与移植研究所透析科对接受维持性血液透析的终末期肾病(ESRD)患者进行。排除正在接受抗病毒药物治疗的患者。在透析开始前立即采集血样,进行乙肝病毒血清学检测、抗丙肝病毒检测、乙肝病毒DNA聚合酶链反应(PCR)及生化检测。对肝脏、脾脏、门静脉直径及有无腹水进行腹部超声检查。使用SPSS 10.0进行数据分析。显著性水平设定为0.05。
在SIUT接受维持性血液透析的1220例ESRD患者中,124例乙肝表面抗原(HBsAg)阳性,但26例因接受抗病毒治疗而被排除。最终98例患者完成研究,其中男性71例(72%),女性27例(28%)。平均年龄为34.98±12.67岁。大多数患者无肝炎症状。62.2%的患者谷丙转氨酶(ALT)水平高于20 IU/ml的临界值,75.4%的患者谷草转氨酶(AST)升高。34.6%的患者e抗原(HBeAg)阳性,65%的患者抗e抗体阳性,65.3%的患者检测到乙肝病毒DNA。超过一半的患者合并丙肝病毒感染。6例患者有肝硬化。34例患者为非复制型携带者。乙肝和丙肝合并感染的患者透析平均时长及HBsAg阳性持续时间显著更长(p<0.05)。
依赖透析的患者感染乙肝病毒大多无症状。常出现轻度转氨酶升高。