丙肝病毒感染的肾移植受者的临床观察  

Clinical observation on renal transplantation recipients with hepatitis C virus infection

作　　者：张萍[1] 段志强[1] 杨丽南[1] 阮一哲[1] 徐海霞[1] 彭燕[1] 彭嘉丽[1] 马小平[1] 

机构地区：[1]解放军452医院肾病内科,成都610021

出　　处：《西南国防医药》2015年第4期377-380,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的对11例丙肝病毒感染的肾移植受者临床资料进行回顾性分析,为今后此类患者的诊疗提供指导。方法纳入2009年5月~2012年5月于我科行肾移植术的丙肝病毒感染患者11例,患者术前丙肝病毒RNA呈阳性、肝酶指标均正常。肾移植术后随访12~48个月,观察患者肝肾功能指标、丙肝病毒基因定量检测变化及排斥反应等发生情况。结果随访期间,所有11例患者中,3例在肾移植术后3 w^8个月出现不同程度的肝功能损伤,给予护肝治疗后肝功均恢复正常;2例发生移植术后新发糖尿病,给予适量胰岛素治疗后血糖水平均控制在正常范围内;4例于移植术后因丙肝病毒复制活跃使用干扰素联合利巴韦林抗病毒治疗,HCV-RNA病毒转阴,其余未抗病毒治疗的7例HCV-RNA较稳定,但仍为阳性,给予检测肝功及护肝治疗。随访期间无患者死亡及移植肾丢失。结论丙肝病毒阳性受者不再是肾移植手术的禁忌证,在进行肾移植术后,应严密监测肝功能及肝炎病毒复制情况。对于肝功能受损患者,应及时给予相应的治疗,并严密监测和处理高血糖等并发症。丙肝病毒阳性受者肾移植术后,短期存活率尚可,而长期存活率还需进一步观察。Objective To make a retrospective analysis on the clinical data on 11 renal transplantation recipients with hepatitis C virus （HCV） infection in order to provide guidance in diagnosis and treatment of such patients. Methods Total I 1 patients with HCV infection to receive renal transplantation in our department from May 2009 to May 2012 were selected as research subjects. Before the operation, the patients were HCV RNA positive and their liver enzymes indexes were normal. After the renal transplantation, they were followed up for 12-48 months in order to observe the liver and renal function indexes, quantitative detection of HCV gene variation, and the occurrence of rejection etc. Results During the follow-up period, among the 11 patients, three ones showed liver function damage in different degree from three weeks to eight months after the operation, and the liver function recovered to normal after hepatic protection treatment; two ones got diabetes, and after appropriate administration of insulin, the blood glucose levels were controlled in the normal range; four ones were administered with interferon and ribavirin antiviral therapy due to the active HCV replication and the HCV-RNA virus became negative; the other ones showed that their HCV-RNA was stable but still positive, so they were provided with liver function examination and liver protection therapy. During the follow-up period, no patients died and no transplanted kidney was lost. Conclusion HCV positive recipients are not any more the contraindication of renal transplantation operation. After renal transplantation, we should closely monitor the liver function and hepatitis virus replication. The patients with impaired liver function should be given appropriate treatment timely, and the complications such as hyperglycemia should be closely monitored and treated. After renal transplantation, HCV positive recipients have certainly a short-term survival rate, but the long-terin survival rate still needs further comparative study.

关 键 词：丙型肝炎 肝炎病毒 肾移植 并发症 预后 

分 类 号：R617[医药卫生—外科学]