乙型肝炎病毒感染者肾移植前肝穿刺活检与预后分析

Liver biopsy and prognosis analysis of patients with hepatitis B virus infection before renal transplantation

背景:乙肝病毒感染者肾移植手术国内有较多报道,但乙肝病毒感染者肾移植前肝穿刺活检观察有限。目的:对慢性肾功能衰竭合并不同程度慢性乙型病毒性肝炎患者进行肾移植前肝穿刺活检,移植后2年随访观察转归情况。方法:对接受肾移植的21例乙型肝炎病毒感染的尿毒症患者进行肝穿刺活检。根据肝活检组织病理学改变,分为轻度(n=9)、中度(n=7)、重度(n=5)3组。肾移植后随访观察2年。3组中各有2例进行重复肝活检组织病理学检查。结果与结论:轻度慢性乙型肝炎组在随访2年中各项观察指标均无明显变化。中度慢性乙型肝炎组从移植后3个月开始谷氨酰转肽酶活性明显高于正常水平,随访至终点时,2例重复肝活检病理显示已处于重度病变。重度慢性乙型肝炎组从移植后3个月开始谷氨酰转肽酶活性持续高于正常水平;18个月开始,血清白蛋白水平低于正常值,球蛋白水平高于正常值;随访至终点时,有4例呈肝硬化改变。提示不同程度的慢性乙型病毒性肝炎患者肾移植后预后不同,肝活检是评价肝脏病变程度的重要手段,具有指导肾移植选择的作用。

BACKGROUND：A number of studies have reported the renal transplantation in patients with hepatitis B virus infection in China,but few research investigates the liver biopsy in hepatitis B virus infection patients before renal transplantation.OBJECTIVE：To conduct the liver biopsy in patients with chronic renal failure and different degrees of chronic hepatitis B before kidney transplantation,and to observe the turnovers during 2-year post-transplant follow-up observations.METHODS：A total of 21 uremic patients with hepatitis B virus infection who are candidates for renal transplantation received liver biopsy.According to pathological changes in liver biopsy,patients were divided into three groups：mild（n = 9）,moderate（n = 7）,and severe（n = 5）.After renal transplantation all patients were followed up for 2 years.There were two cases in each of three groups undergoing repeated liver biopsy for histopathological examination.RESULTS AND CONCLUSION：All observation indicators showed no significant changes in patients with mild chronic hepatitis B in the 2-year follow-up.In the patients with moderate chronic hepatitis B,the glutamyl transpeptidase activity was significantly higher than normal level from 3 months after transplantation,and two cases were diagnosed as severe disease by repeated liver biopsy at the end of follow-ups.In the patients with severe chronic hepatitis B,the glutamyl transpeptidase activity was higher than normal levels from 3 months after transplantation;the serum albumin was lower than normal levels from 18 months,but the globulin levels were higher than normal;four cases showed cirrhosis changes at the end of follow-ups.The experimental results indicate that,the prognosis alter in patients with different degrees of chronic hepatitis B after renal transplantation,and liver biopsy is an important means to evaluate the lesion degree of liver disease and it can guide the effect of renal transplantation.