肾移植患者丙型肝炎病毒感染的临床研究

THE CLINICAL STUDY OF HEPATITIS C VIRUS (HCV) INFECTION ON RENAL TRANSPLANTATION

目的：了解肾移植患者丙型肝炎病毒（ＨＣＶ）的感染情况及ＨＣＶ感染后的临床影响。方法：对６７例肾移植患者进行至少１年的随访，用第二代ＥＬＩＳＡ法和Ｎｅｓｔ－ＰＣＲ测定血清中抗ＨＣＶ和ＨＣＶＲＮＡ。结果：抗ＨＣＶ的阳性率５０．７％（３４例），ＨＣＶＲＮＡ的阳性率为４７．８％（３２例）。ＨＣＶＲＮＡ阳性组术前血透时间和输血量及丙氨酸转移酶（ＡＬＴ）水平明显高于ＨＣＶＲＮＡ阴性组，ＨＣＶＲＮＡ阳性组术前与术后ＡＬＴ水平差异不显著。术后ＨＣＶＲＮＡ阳性组的ＡＬＴ水平和肝脏损害的发病率明显高于ＨＣＶＲＮＡ阴性组，感染、排斥反应、移植物的存活率、肌酐水平在两组中差异不显著。结论：本研究显示，ＨＣＶ感染主要影响肾移植患者的肝脏病变，在短期内对患者的感染、排斥反应、移植物的存活率无显著影响，表明ＨＣＶ感染不是肾移植的禁忌证。

OBJECTIVE To evaluated the incidence and influence of HCV infection in renal transplantation.METHODOLOGY Sixty seven renal transplant patients were followed up for more than 1 year.Serum antibodies to HCV was detected by second generation ELISA and HCVRNA by Nest PCR.RESULTS The prevalence of antiHCV antibody was 507%(n=34),and the prevalence of HCVRNA was 478%(n=32).The patients with positive HCVRNA had a much longer duration of dialysis(P<005)and had received more blood transfusing before transplantation than patients with negative HCVRNA.No significant difference of ALT levels was found in this group of patients before and after transplantation.ALT level was significantly higher in HCVRNA positive patients than in HCVRNA negative patients.No differences in the rate of other infection,rejection rate,graft survival rate,and serum creatinine levels were found between HCVRNA positive and negative patients.CONCLUSION The rate of short term rejection and survival and the rate of other infections are not affected by the positivity of HCV antibodies and HCVRNA.