Delayed referral for dialysis.
Delayed referral for dialysis.
复制标题
延迟转诊进行透析。
DOI：
10.1093/ndt/11.11.2124
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
D. Eadington
中科院分区：
文献类型：
--
作者：
D. Eadington
免疫抑制治疗可能会增强病毒复制，加剧或加速慢性乙型肝炎和丙型肝炎的进展。晚期减少硫唑嘌呤剂量似乎不会对慢性乙型肝炎的自然病程造成任何改变，因此早期减少药物剂量可能是此类患者的一种可能方法。皮质类固醇似乎特别有害，因为它们有利于病毒复制。为了避免或尽量减少这种风险，从移植时起泼尼松的维持剂量应尽可能低。由于越来越多的证据表明单独使用环孢菌素可能会导致良好的移植物存活，因此可以尝试对 HBsAg 阳性和/或 HCV 阳性患者进行无类固醇免疫抑制治疗。这是更合理的，因为 HBsAg 阳性和/或 HCV 阳性患者的免疫反应性较低。然而不幸的是，尚未对此类病毒感染的免疫抑制患者进行具体试验。尽管移植后应尽可能减少免疫抑制治疗，但不可忽视的是，肝功能恶化的患者快速减少免疫抑制治疗在某些情况下可能会加速肝损伤。这种矛盾的反应可能是由于以下事实：虽然免疫抑制剂可以防止对病毒的自身免疫反应，但在某些情况下，突然减少或停止免疫抑制治疗可能会导致细胞溶解和肝脏的进一步破坏。
Immunosuppressive therapy may enhance viral replication and exacerbate or accelerate the progression of chronic hepatitis B and C. A late reduction in the dosage of azathioprine seems not to cause any changes in the natural course of chronic hepatitis B, and therefore an early reduction in the dosage of the drug might be a possible approach for such patients. Corticosteroids seem to be particularly harmful, in that they favour viral replication. To avoid or minimize this risk the maintenance doses of prednisone should be kept as low as possible from the time of transplantation. As there is growing evidence that cyclosporin alone may lead to excellent graft survival, steroid-free immunosuppression might be tried for HBsAg-positive and/or HCV-positive patients. This is even more justified since HBsAg-positive and/or HCV-positive patients have a lower immunological reactivity. Unfortunately, however, no specific trial with such an immunosuppressive patients with viral infection has been done. Although immunosuppressive therapy should be kept as low as possible after transplantation, it cannot be ignored that rapid reduction of immunosuppressive therapy in patients with deteriorating liver function might accelerate liver damage in some cases. This paradoxical response is probably due to the fact that while immunosuppressive agents may protect from the autoimmune response to virus, in some cases an abrupt reduction or discontinuation of immunosuppressive therapy might lead to cytolysis and further destruction of the livers.
丙型肝炎病毒感染对同种异体肾移植受者的影响。
影响因子：
19.6
作者：
Roth,D;Zucker,K;Cirocco,R;DeMattos,A;Burke,GW;Nery,J;Esquenazi,V;Babischkin,S;Miller,J
通讯作者：
Miller,J
影响因子：
158.5
作者：
OWEN, WF;LEW, NL;LAZARUS, JM
通讯作者：
LAZARUS, JM