Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation
Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation
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终末期肾病患者的慢性丙型肝炎感染：等待肾移植患者的肝脏组织学和病毒载量特征
DOI：
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发表时间：
1999
影响因子：
9.8
通讯作者：
M. Shiffman
中科院分区：
文献类型：
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作者：
R. Sterling;A. Sanyal;V. Luketic;T. Stravitz;A. King;A. Post;S. Mills;M. Contos;M. Shiffman
目的：丙型肝炎病毒（HCV）在等待肾移植（RT）的终末期肾病（ESRD）患者中很常见。然而，相对于HCV和肾功能正常的患者，这些患者的肝脏组织学和病毒滴度的数据很少。本研究的目的是评估等待RT的ESRD患者的肝脏组织学、定量HCV-RNA滴度和丙氨酸转氨酶（ALT）水平，并确定组织学进展为晚期桥性纤维化和/或肝硬化的临床预测因素。方法：共有50例等待RT的ESRD和HCV患者（平均年龄42岁，62%为男性）连续接受肝活检。两组HCV人群，一组ALT持续正常，另一组ALT升高，均肾功能正常，作为对照。采用定量PCR检测HCV-RNA滴度。结果：在ESRD患者中，94%的患者ALT正常。ESRD患者的Log HCV RNA滴度（5.8±0.3）明显高于ALT正常（5.4±0.1）或ALT升高（5.3±0.1）的对照组（p < 0.05）。ESRD患者的Knodell组织学活动指数（HAI）与ALT正常对照组相似（4.8±0.4 vs 4.9±0.4），但显著低于ALT升高对照组（8.4±0.5）（p < 0.05）。在ESRD患者和ALT持续正常的对照组中，桥接纤维化或肝硬化患者的比例相似（22%vs 13%），但显著低于ALT升高的对照组（48%）。在伴有晚期纤维化的ESRD患者（n = 11）和伴有轻度疾病的ESRD患者（n = 39）之间，ALT、HCV-RNA滴度、血液透析持续时间或首次可能暴露的时间均无显著差异。结论：我们的数据表明，肝活检对于排除HCV和ESRD患者明显的肝脏病理是必要的，并有助于确定干扰素治疗可能对哪些患者有帮助。
OBJECTIVES:Hepatitis C virus (HCV) is common in patients with end stage renal disease (ESRD) awaiting renal transplantation (RT). However, few data are available on the liver histology and viral titer in these patients relative to patients with HCV and normal renal function. The aims of this study were to assess liver histology, quantitative HCV-RNA titer, and alanine aminotransferase (ALT) levels in patients with ESRD awaiting RT, and to identify clinical predictors of histological progression to advanced bridging fibrosis and/or cirrhosis.METHODS:A total of 50 consecutive patients (mean age 42 yr, 62% male) with ESRD and HCV, who were awaiting RT, underwent liver biopsy. Two HCV populations, one with persistently normal ALT and another with elevated ALT, both with normal renal function, served as controls. HCV-RNA titer was assessed by quantitative PCR.RESULTS:Of the patients with ESRD, 94% had normal ALT. Log HCV RNA titer was significantly higher in patients with ESRD (5.8 ± 0.3) than in either normal ALT (5.4 ± 0.1) or elevated ALT (5.3 ± 0.1) controls (p < 0.05). Knodell Histological Activity Index (HAI) in patients with ESRD was similar to that observed in control patients with normal ALT (4.8 ± 0.4 vs 4.9 ± 0.4) but significantly less (p < 0.05) than that observed in control patients with elevated ALT (8.4 ± 0.5). The percentage of patients with bridging fibrosis or cirrhosis was similar in patients with ESRD and controls with persistently normal ALT (22%vs 13%) but significantly less (p < 0.001) than that observed in control patients with elevated ALT (48%). No significant differences in ALT, HCV-RNA titer, duration on hemodialysis, or time from first possible exposure was observed between ESRD patients with advance fibrosis (n = 11) and those with mild disease (n = 39).CONCLUSIONS:Our data suggest that liver biopsy is necessary to exclude significant liver pathology in patients with HCV and ESRD, and to help define those patients in whom interferon treatment might be helpful.