Ibrahim Mohamed A, Mostafa Afaf A, El-Said Heba W, Mohab Amr M, Hebah Hayam A
Department of Nephrology, Ain Shams University, Cairo, Egypt.
Hemodial Int. 2014 Oct;18 Suppl 1:S23-31. doi: 10.1111/hdi.12220.
Hemodialysis (HD) may adversely affect the immune system. It is established that intercurrent infection rate and severity may be increased in prevalent HD patients. Moreover, hepatitis C viral infection, a common infection in many HD centers, may further inhibit the immune system. To our knowledge, no previous study in the literature has attempted to investigate the possible effects of hepatitis C seropositivity on rate and severity of intercurrent infection in prevalent HD patients. The aim of this study was to assess the peripheral blood CD16-natural killer cells, CD4/CD8 ratio, as well as rate of intercurrent infection in hepatitis C seropositive prevalent HD patients as compared with hepatitis C seronegative prevalent HD patients. Twenty hepatitis C seropositive stable prevalent HD patients (group A), as well as another twenty hepatitis C seronegative stable prevalent HD patients (group B), were randomly selected from our HD unit and enrolled in the study. Both groups were similar in age, sex, body mass index, and duration of HD. Diabetics, smokers, and cases with advanced liver disease (Child classification stages B and C) were excluded from the study. A third group (group C) of 10 apparently healthy subjects (of similar age, sex, and body mass index), was also enrolled in the study. All subjects were investigated by complete blood count, routine chemistry, assessment of peripheral lymphocytes CD3,CD16, CD4, CD8, CD4/CD8 ratio by flow cytometer, as well assessment of intercurrent infection frequency retrospectively (since the start of HD therapy and seroconversion in HD patients, and prospectively for a period of six months. Although we detected statistically significant higher frequency of intercurrent infection in both HD groups compared with the healthy group, we did not detect significant differences between hepatitis C seropositive and seronegative groups regarding frequency or severity of intercurrent infection. Moreover, we did not detect significant differences among the three studied groups regarding levels of CD16, CD3, CD4, CD8, CD4/CD8 ratio in peripheral lymphocytes. It may be concluded that hepatitis C seropositive prevalent HD patients are not at increased risk of intercurrent infection as compared with hepatitis C seronegative prevalent HD patients, contrary to what is reported in hepatitis C seroconverted organ transplant candidates.
血液透析（HD）可能会对免疫系统产生不利影响。已证实，维持性血液透析患者的并发感染率及严重程度可能会增加。此外，丙型肝炎病毒感染在许多血液透析中心是一种常见感染，它可能会进一步抑制免疫系统。据我们所知，此前文献中尚无研究试图探讨丙型肝炎血清学阳性对维持性血液透析患者并发感染率及严重程度的可能影响。本研究的目的是评估丙型肝炎血清学阳性的维持性血液透析患者与丙型肝炎血清学阴性的维持性血液透析患者相比，其外周血CD16自然杀伤细胞、CD4/CD8比值以及并发感染率。从我们的血液透析单元中随机选取20例丙型肝炎血清学阳性的稳定维持性血液透析患者（A组）以及另外20例丙型肝炎血清学阴性的稳定维持性血液透析患者（B组）纳入研究。两组在年龄、性别、体重指数和血液透析持续时间方面相似。糖尿病患者、吸烟者以及晚期肝病患者（Child分级B和C期）被排除在研究之外。还纳入了第三组（C组）10名明显健康的受试者（年龄、性别和体重指数相似）。所有受试者均接受全血细胞计数、常规生化检查，通过流式细胞仪评估外周淋巴细胞CD3、CD16、CD4、CD8、CD4/CD8比值，并回顾性评估并发感染频率（自血液透析治疗开始及血液透析患者血清转化以来）以及前瞻性评估为期6个月的并发感染频率。尽管我们检测到两个血液透析组的并发感染频率在统计学上显著高于健康组，但我们未检测到丙型肝炎血清学阳性组和血清学阴性组在并发感染频率或严重程度方面存在显著差异。此外，我们未检测到三个研究组在外周淋巴细胞中CD16、CD3、CD4、CD8、CD4/CD8比值水平方面存在显著差异。可以得出结论，与丙型肝炎血清学阴性的维持性血液透析患者相比，丙型肝炎血清学阳性的维持性血液透析患者并发感染风险并未增加，这与丙型肝炎血清转化的器官移植候选者的报道情况相反。
