肾移植患者丙型肝炎病毒感染的研究

Kidney transplant patients with hepatitis C virus infection:clinical,pathologic,and immunohistochemical study

目的 了解肾移植患者HCV感染情况及感染对临床影响。 方法 对 6 7例肾移植患者进行至少 1年的随访 ,用第二代酶联免疫吸附法 (第二代ELISA法 )和巢式多聚酶链反应 (Nest PCR法 )测定血清中丙型肝炎病毒抗体 (抗HCV)和丙型肝炎病毒核糖核酸 (HCVRNA) ,免疫组化链霉亲合素标记的酶联法 (LSAB法 )测定丙型肝炎病毒非结构区 3区、5区基因表达的抗原 (HCV NS3、NS5抗原 )。 结果 抗HCV阳性率 5 0 75 % (34例 ) ,HCVRNA的阳性率为 47 76 % (32例 )。 HCVRNA阳性组术前血透时间、输血量及术后平均谷丙转氨酶 (ALT)、肝脏损害的发病率明显大于HCVRNA阴性组 ,术后两组患者肌酐水平、患者和移植肾的 1年存活率、感染和急性排斥反应的发生率无显著差异。LSAB法显示 3例HCVRNA阳性患者肝穿刺标本有两例肝组织内HCV NS3、NS5抗原呈阳性。 结论 HCV感染可导致肾移植患者肝脏病变 ,在短期内对患者的移植肾功能、感染和急性排斥反应的发生率、患者和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症。

Objective[WT5”BZ] To evaluate the clinical results of kidney transplant patients with hepatitis C virus(HCV) infection. [WT5”HZ]Methods[WT5”BZ] We tested the sera from 67 patients for anti HCV and HCV RNA using second generation ELISA and Nest PCR; HCV NS3,NS5 were tested by immunohistochemistry LSAB. All patients were followed up for 1 year. [WT5”HZ]Results[WT5”BZ] The prevalence of anti HCV was 50.75%( n =34),and the rate of HCV RNA was 47 76%( n =32).The HCV RNA positive group had a much longer duration of dialysis and had received more blood transfusion than HCV RNA negtive group before transplantation. ALT levels and prevalence of liver dysfunction were significantly higher in HCV RNA positive group after transplantation; however,there was no difference in infection, rejection, graft survival and serum creatinine level. LSAB suggested that HCV NS3, NS5 antigen of two from three liver bioptic specimens with HCV RNA positive patients were positive. [WT5”HZ]Conclusions[WT5”BZ] HCV infection in renal transplant patients can result in liver disease,and is not significantly associated with infection, rejection, and graft survival within a short time. We consider HCV not a contraindication to renal transplantation. [WT5”HZ]