透析前患者中隐匿性丙型肝炎感染的高患病率。

High prevalence of occult hepatitis C infection in predialysis patients.

作者信息

Sette Luís Henrique Bezerra Cavalcanti, Lopes Edmundo Pessoa de Almeida, Guedes Dos Anjos Nathália Campello, Valente Lucila Maria, Vieira de Oliveira Sávio Augusto, Lucena-Silva Norma

机构信息

Nephrology-Department of Clinical Medicine, Federal University of Pernambuco, Pernambuco 50670-901, Brazil.

Gastroenterology-Department of Clinical Medicine, Federal University of Pernambuco, Pernambuco 50670-900, Brazil.

出版信息

World J Hepatol. 2019 Jan 27;11(1):109-118. doi: 10.4254/wjh.v11.i1.109.

DOI:10.4254/wjh.v11.i1.109

PMID:30705723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6354127/

Abstract

BACKGROUND

Occult hepatitis C virus (HCV) infection (OCI) may be associated with extrahepatic diseases and it is known that the patients with chronic kidney disease (CKD) who are on hemodialysis (HD) present a higher prevalence of this type of infection than the general population, with a worse clinical outcome. However, there are no data in the literature to assess the presence of OCI in patients prior to the initiation of renal replacement therapy (RRT). Therefore, this study aimed to evaluate the occurrence and epidemiological aspects of OCI in patients with Predialysis CKD. We hypothesize that this infection could occur before RRT initiation.

AIM

To research the status in predialysis patients when HD patients have high prevalence of OCI.

METHODS

A cross-sectional study was conducted between 2015 and 2017. Adults with creatinine clearance < 60 mL/min·1.73 m (predialysis patients) were recruited to the study. Pregnant and postpartum women, patients with glomerulopathies, and patients showing positivity for serological markers of hepatitis B virus (HBV), HCV or human immunodeficiency virus infection were excluded. Patients were diagnosed with OCI according to test results of anti-HCV antibody negativity and HCV RNA positivity in either ultracentrifuged serum or, if serum-negative, in peripheral blood mononuclear cells.

RESULTS

Among the 91 total patients included in the study, the prevalence of OCI was 16.5%. Among these 15 total OCI patients, 1 was diagnosed by 14 ultracentrifuged serum results and 14 were diagnosed by peripheral blood mononuclear cell results. Compared to the non-OCI group, the OCI patients presented higher frequency of older age ( = 0.002), patients with CKD of mixed etiology ( = 0.019), and patients with markers of previous HBV infection (., combined positivity for anti-hepatitis B core protein antibody and anti-hepatitis B surface protein antibody) ( = 0.001).

CONCLUSION

Among predialysis patients, OCI involved the elderly, patients with CKD of mixed etiology, and patients with previous HBV infection.

摘要

背景

隐匿性丙型肝炎病毒（HCV）感染（OCI）可能与肝外疾病有关，并且已知接受血液透析（HD）的慢性肾脏病（CKD）患者中，这类感染的患病率高于普通人群，临床结局更差。然而，文献中尚无数据评估肾替代治疗（RRT）开始前患者中OCI的存在情况。因此，本研究旨在评估透析前CKD患者中OCI的发生情况及流行病学特征。我们推测这种感染可能在RRT开始前就已发生。

目的

研究HD患者中OCI患病率高时透析前患者的状况。

方法

于2015年至2017年进行了一项横断面研究。招募肌酐清除率<60 mL/min·1.73 m²的成年人（透析前患者）参与研究。排除孕妇和产后妇女、患有肾小球病的患者以及乙型肝炎病毒（HBV）、HCV或人类免疫缺陷病毒感染血清学标志物呈阳性的患者。根据超速离心血清中抗HCV抗体阴性和HCV RNA阳性的检测结果，或在血清为阴性时根据外周血单个核细胞的检测结果，诊断患者是否患有OCI。

结果

在纳入研究的91例患者中，OCI患病率为16.5%。在这15例OCI患者中，1例通过14份超速离心血清检测结果确诊，14例通过外周血单个核细胞检测结果确诊。与非OCI组相比，OCI患者年龄较大的频率更高（P = 0.002），混合病因CKD患者的频率更高（P = 0.019），既往有HBV感染标志物（即抗乙肝核心蛋白抗体和抗乙肝表面蛋白抗体联合阳性）的患者频率更高（P = 0.001）。