Department of Hepatology, The First Hospital of Jilin University, Jilin University, Changchun, 130021, China.
Department of Hepatology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China.
Sci Rep. 2019 Feb 13;9(1):1910. doi: 10.1038/s41598-018-36437-6.
Hepatitis C virus (HCV) infection greatly increases the risk of nephropathy. In this observational study, we aimed to explore the relationship between viral hepatitis infection and chronic kidney disease (CKD), identify risk factors, and determine the effect of antiviral treatment on CKD in Chinese patients with chronic HCV infection. A total of 2,435 study subjects were enrolled and divided into four groups: the HCV infection, HBV infection, HBV and HCV co-infection, and uninfected control groups. Of these, 207 patients with chronic hepatitis C (CHC) were given standard dual therapy [subcutaneous injection of recombinant interferon (IFN)-α2b and oral ribavirin (RBV)] for 48 weeks. We found that the prevalence of CKD gradually increased with age in all groups and was significantly increased in patients 60 years or older. Multivariate logistic regression analyses showed that persistent HCV infection was significantly associated with CKD [odds ratio (OR), 1.33; 95% confidence interval (CI), 1.06-1.66; P = 0.013], whereas there was no significant link between CKD and spontaneous HCV clearance (OR, 1.23; 95% CI, 0.79-1.90; P = 0.364), HBV infection (OR, 0.73; 95% CI, 0.44-1.19; P = 0.201), or HBV/HCV co-infection (OR, 1.40; 95% CI, 0.81-2.40; P = 0.234). Notably, after anti-HCV therapy, the serum creatinine concentration was significantly decreased (76.0, 75.5-79.4 μmol/L) from the pretreatment level (95.0, 93.0-97.2 μmol/L), both in patients who showed an end of treatment virological response (ETVR) and those who did not (P < 0.001). Also, in both the ETVR and non-ETVR groups, the percentages of patients with an estimated glomerular filtration rate (eGFR) ≥90 ml/min/1.73 m increased significantly (P < 0.001), whereas the percentages of those with an eGFR <60 ml/min/1.73 m significantly decreased (P < 0.001). In conclusion, persistent HCV infection was independently associated with CKD, and antiviral treatment with IFN plus RBV can improve renal function and reverse CKD in HCV-infected patients.
丙型肝炎病毒（HCV）感染大大增加了肾病的风险。在这项观察性研究中，我们旨在探讨病毒肝炎感染与慢性肾脏病（CKD）之间的关系，确定风险因素，并确定慢性 HCV 感染中国患者抗病毒治疗对 CKD 的影响。共纳入 2435 名研究对象，分为 HCV 感染、HBV 感染、HBV 和 HCV 合并感染以及未感染对照组。其中，207 名慢性丙型肝炎（CHC）患者接受标准双药治疗[皮下注射重组干扰素（IFN）-α2b 和口服利巴韦林（RBV）]48 周。我们发现，所有组的 CKD 患病率均随年龄增长而逐渐增加，且 60 岁及以上患者明显增加。多变量 logistic 回归分析显示，持续 HCV 感染与 CKD 显著相关[比值比（OR），1.33；95%置信区间（CI），1.06-1.66；P=0.013]，而自发 HCV 清除（OR，1.23；95%CI，0.79-1.90；P=0.364）、HBV 感染（OR，0.73；95%CI，0.44-1.19；P=0.201）或 HBV/HCV 合并感染（OR，1.40；95%CI，0.81-2.40；P=0.234）与 CKD 无显著相关性。值得注意的是，抗 HCV 治疗后，血清肌酐浓度从治疗前水平（95.0，93.0-97.2 μmol/L）显著降低（76.0，75.5-79.4 μmol/L），无论是在达到治疗结束病毒学应答（ETVR）的患者还是未达到 ETVR 的患者中（P<0.001）。此外，在 ETVR 和非 ETVR 组中，肾小球滤过率（eGFR）≥90 ml/min/1.73 m 的患者比例均显著增加（P<0.001），而 eGFR<60 ml/min/1.73 m 的患者比例显著降低（P<0.001）。总之，持续的 HCV 感染与 CKD 独立相关，IFN 加 RBV 的抗病毒治疗可改善 HCV 感染患者的肾功能并逆转 CKD。
