乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者长期预后影响  

Impact of Hepatitis B and Hepatitis C virus Infections on Patients and Allograft Outcomes in Renal Transplant Recipients

作　　者：韩国锋[1,2] 胡大勇[2] 顾勇[1] 孙晶[2] 张金元[2] 

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040 [2]解放军第455医院肾脏科,上海200052

出　　处：《中国临床医学》2009年第3期406-409,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:研究乙型肝炎病毒和(或)丙型肝炎病毒感染对肾移植受者的长期预后的影响。方法:比较术前乙型肝炎病毒表面抗原(HBsAg)阳性或(和)丙型肝炎病毒抗体(抗-HBV)阳性与HBsAg和抗-HCV均阴性肾移植术患者的预后,用Kaplan-Meier法统计生存率。结果:肝炎病毒阴性受者的生存率和肾存活率分别为:1年94%和92.3%;3年88.6%和86.5%;5年83%和79.6%;10年69.9%和54%;肝炎病毒阳性受者的生存率和肾存活率分别为:1年98%和95.9%;3年91.3%和89.3%;5年79%和80.8%;10年64.7%和64.7%,阳性和阴性者相比生存率无明显差别。1999年前免疫抑制剂以环孢素A(CsA)、硫唑嘌呤(Aza)和激素为主,肝炎病毒阳性者5年和10年人生存率低于阴性患者,移植肾生存率无差别。肝炎病毒阳性受者死亡8例,4例死因为肝功能衰竭或肝硬化。1999年后吗替麦考酚酯(MMF)及他克莫司(FK506)应用于抗排斥治疗,肝炎病毒阳性和阴性受者移植肾和患者生存率均无差异,29例阳性者仅1例死亡,原因为移植肾失功后尿毒症。结论:在以CsA和Aza为主要免疫抑制剂的年代,肝相关并发症是肝炎病毒阳性肾移植受者重要死因,但肝炎病毒阳性与阴性者相比生存率、肾活率无明显差别。新型免疫抑制剂的应用和移植前后正确处理,可能改善乙型或丙型肝炎病毒感染肾移植受者预后。Objective： To study the impact of hepatitis B virus （HBV）infection and/or hepatitis C virus （HCV） infection on the long term outcomes of renal allograft recipients. Methods： Retrospective case-control study was carried on in our hospital to compare the outcomes of 49 patients with HBV ＋/HCV ＋ and that of 183 patients without HBV/HCV infection. Results： Patients and renal graft survival rate in HBV and HCV negative patients were： 1 year 94% and 92. 3%, 3 years 88.6% and 86.5 %, 5 year 83 % and 79.6%, 10 years 69.9% and 54%, respectively. Patients and renal graft survival rates in recipients with HBV＋/HCV＋ were： 1 year 98% and 95.9%, 3 years 91.3% and 89.3%, 5 years 79%and 80.8%;10 years 64.7% and 64.7 %, the survival rates were not obvious different between HBV ＋/HCV ＋ and HBV-/HCV- groups. But before 1999 when the primary immunosuppressive agents were eielosporin A （CsA）, azathioprim（AZA） and eortieosteroid, the patients survival rate was lower in HBV＋/HCV＋ patients, 4 of 8 （50%） dead causes were hepatic complications. After 1999 when some new immunosuppressive agents were used in clinical, 1 of 29 HBV ＋/HCV ＋ patients died from uremia after renal graft loss. Conclusion.. Even though hepatic complication was the leading cause of death in HBV ＋/HCV ＋ renal allograft recipients in the era of CsA and AZA, the overall graft and patient survival were not obvious different between patients with HBV ＋/ HCV ＋ or HBV/HCV . Carefully selecting candidate, regular monitoring after transplantation and using less liver-toxic drugs may improve the outcomes of renal allograft recipients with hepatitis virus infection.

关 键 词：乙型肝炎 丙型肝炎 肾移植 预后 

分 类 号：R512.62[医药卫生—内科学] R512.63[医药卫生—临床医学]