乙、丙型肝炎病毒感染的肾移植受者肝损害临床观察

摘要

Objective : To observe the clinical characteristics of liver damage in the renal allograft recipients with hepatitis B and hepatitis C Infection.Methods : A retrospective review of clinical manifestation was processed in 266 renal allograft recipients.65( 65/266 )cases with the infection of hepatitis B and hepatitis C virus( HBV and HCV ) hefore operation were divided into positive group, and 201( 201/266 ) cases without infection hefore operation were as negative control.All patients were treated with the similar immunosuppressive agents and liver protective medicine after operation.The liver function test, HBVDNA, HCVRNA and the concentration of CsA were monitored.The liver biopsy specimens from 28 patients with chronic hepatitis B and C were assessed.Results :The morbility and mortality of liver damage in the patients with HBV and HCV infection were significantly higher than those without infection.In the sole HBV infection, the degree of liver dysfunction was severer, the inflammatory activity index of liver tissue was higher,and 9 cases fibrosing cholestatic hepatitis( FCH ) were found.Conclusion : The incidence of liver damage in the renal allograft recipients with infection of HBV and HCV is higher after operation, the strict evaluation of liver function should be suhjected hefore operation.The liver damage of renal allograft patients with sole HBV infection should be paid more attention, and treated with protective FCH.%目的:观察乙、丙型肝炎病毒感染的肾移植受者术后肝损害的临床特点.方法:回顾性分析并跟踪观察了266例同种异体肾移植术受者的临床资料.65(65/266)例术前乙、丙肝炎病毒感染者作为阳性组,其中单一HBVM阳性者38例,单一抗HCV阳性者12例,HBVM/抗HCV双阳性15例;同期无病毒感染者201(201/266)例为阴性组.术后均采用三联免疫抑制方案及护肝药物治疗,同时监测肝功能、HBVDNA、HCVRNA及CsA药物浓度.28例术后乙、丙型肝炎受者作肝组织常规病理学检查.结果:乙、丙型肝炎病毒感染阳性组术后肝损害发病率及病死率明显高于阴性组.单一HBV感染所致的肝功能损害程度重,肝组织炎性活动积分高,9例发生了纤维化瘀胆性肝炎.结论:乙、丙型肝炎病毒感染的肾移植受者术后易出现肝脏损害,术前应对肝脏功能进行严格评估,单一HBV感染受者应防止纤维化瘀胆性肝炎的发生.