维持性血液透析丙型肝炎病毒感染患者的抗病毒治疗及预后  

Antiviral treatment and prognosis in patients undergoing maintenance hemodialysis due to hepatitis C virus

作　　者：张唯伟 袁琼婧[1] 宁建平[1] 李霞[1] 吴安华[2] 肖湘成[1] ZHANGWeiwei;YUAN Qiongjing;NING Jianping;LI Xia;WUAnhua;XIAO Xiangcheng(Department of Nephrology,Xiangya Hospital,Central South University,Changsha 410008;Center for Healthcare-Associated Infection Control,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院肾病内科,长沙410008 [2]中南大学湘雅医院感染控制中心,长沙410008

出　　处：《中南大学学报（医学版）》2021年第12期1332-1337,共6页Journal of Central South University ：Medical Science

基　　金：湖南省重点研发计划(2018WK2061);湖南省自然科学基金(2019JJ40515,2019JJ20035)。

摘　　要：目的:维持性血液透析(maintenance hemodialysis,MHD)是终末期肾病患者重要的替代治疗方法之一。丙型肝炎病毒(hepatitis C virus,HCV)感染是全球严重的公共卫生问题,MHD患者合并HCV感染的比例及不良预后风险高于一般人群,积极的抗病毒治疗并预防再次感染事件的发生是肾病内科与感染病科医师联合治疗理念的体现。为HCV感染治愈患者设置血液透析缓冲区是一个有效的预防措施,但其有效性及安全性仍需进一步探究。本研究旨在探索MHD合并HCV感染患者在血液透析过程中的抗病毒治疗方案及预后情况。方法:回顾性分析中南大学湘雅医院血液净化中心HCV区10例长期血液透析终末期肾病患者的病历资料。完成规范的抗病毒药物治疗方案12周或24周后监测血清HCV-RNA为阴性,视为达到HCV治愈标准。湘雅医院肾病内科于2017年4月在血液净化中心设置缓冲区,安排HCV感染已治愈的患者由HCV区转入缓冲区继续透析,转区后监测这类患者血清HCV-RNA、抗HCV抗体水平以及临床生化指标,并随访观察HCV治愈后再次感染的情况。结果:10例HCV感染患者经抗病毒治疗后最终均治愈,治疗前后临床生化指标未见显著变化,转区后经27.5(17.5,39.0)个月随访,患者HCV-RNA持续阴性,抗HCV抗体持续阳性。结论:采用直接抗病毒治疗MHD合并HCV感染患者安全、有效,积极的抗病毒治疗及HCV转阴患者缓冲区透析是HCV患者在MHD期间新型有效的治疗模式。Objective:Maintenance hemodialysis(MHD)is one of the important renal replacement therapies for patients with end-stage renal disease.Hepatitis C virus(HCV)infection is a serious global public health problem.The proportion of MHD patients complicated with HCV infection and the risk of adverse prognosis are higher than those in the general population.Active antiviral treatment and prevention of reinfection is a combined treatment by nephrology and infection physicians.It is a widely accepted preventive measure to set hemodialysis buffer area for patients in treating HCV infection,but its effectiveness and safety still need to be further explored.Thus,the aim of this study is to explore the antiviral treatment and prognosis of MHD patients with HCV infection during hemodialysis.Methods:A retrospective analysis for renal disease patients at 10 end-stage with long-term hemodialysis in the HCV area of the Blood Purification Center of Xiangya Hospital,Central South University.After standard antiviral drug treatment,the patient reached the cure standard for HCV infection.The buffer zone was set up in the Blood Purification Center by the Department of Nephrology of Xiangya Hospital since April 2017.Patients cured of HCV infection were transferred from the HCV area to the buffer zone for continuous dialysis,accompanied by monitoring serum HCV-RNA,anti-HCV antibody levels and changes in clinical biochemical indicators following the status of reinfection.Results:Ten patients with HCV infection were finally cured after antiviral treatment,and there were no significant changes in clinical biochemical indicators before and after treatment.In the followed-up period after the transfer,the patient continued to be negative for HCV-RNA and positive for anti-HCV antibody.Conclusion:Direct antiviral therapy is safe and effective in MHD patients with HCV infection.Active antiviral therapy and transferring to the buffer area for dialysis are new and effective treatment modes for HCV patients during MHD.

关 键 词：丙型肝炎病毒 维持性血液透析 抗丙型肝炎病毒治疗 血液透析缓冲区 

分 类 号：R512.63[医药卫生—内科学]