摘要
目的：研究肾移植患者丙型肝炎病毒（ＨＣＶ）的感染率及其临床特点，探讨ＨＣＶ感染对肾移植患者的影响。方法：应用套式反转录多聚酶链式反应（ＲＴ－ＰＣＲ）及第二代ＥＬＩＳＡ方法检测４９例肾移植患者及３６例供体的血清ＨＣＶ－ＲＮＡ及抗ＨＣＶ抗体（Ａｎｔｉ－ＨＣＶ）。结果：肾移植患者ＨＣＶ感染率为６２．２％。术后第４周及第１２周ＨＣＶ－ＲＮＡ的检出率明显高于Ａｎｔｉ－ＨＣＶ，分别为：６１．７％ｖｓ４０．４％和６２．２％ｖｓ３５．６％。３６例供体中５例Ａｎｔｉ－ＨＣＶ（＋），其中４例ＨＣＶ－ＲＮＡ（＋）。４例术前无ＨＣＶ感染的患者接受ＨＣＶ阳性的供肾，于术后１２周之内３例患者血清ＨＣＶ－ＲＮＡ转为阳性．术后１２周内，ＨＣＶ感染和无ＨＣＶ感染者之间的急性排异的发生率无显著差异。结论：①肾移植患者术后３个月内ＨＣＶ感染率明显高于普通人群。②ＨＣＶ阳性供肾可使受者遭受感染。③肾移植患者的肝脏酶谱升高不能作为诊断ＨＣＶ感染的敏感指标，肝脏组织病理学及ＲＴ－ＰＣＲ方法测定肝组织内ＨＣＶ－ＲＮＡ是诊断丙型肝炎最可靠的方法。
BJECTIVESHepatitisCvirus(HCV)infectionisanimportantprobleminrenaltransplantation.TheprevalenceandtransmisionmodesofHCVinfectioninrenaltransplantrecipientshasnotyetbeenextensivelyexaminedinChina.Inthisstudy,anretrospectiveanalysiswereperformedin49renaltransplantrecipientstodeterminetheprevalenceandmajortransmissionmodeofHCVinfectioninthisgroupofpatients.METHODOLOGYSerumantibodytoHCV(Anti-HCV)wasmeasuredbysecondgenerationELISAassayandHCV-mRNAwasdetectedbyreversetranscriptionandnestPCRin49renaltransplantrecipi-entsand36cadavericdonors.RESULTSBeforetransplantation,theincidenceofHCVinfection(anti-HCVand/orHCV-RNAposi-tive)inpre-operationpatientswas46.9%.ComparedtoHCV(-)patients,HCVinfectedpatientshadalongerdurationofhemodialysis(P<0.001)andhadreceivedmorebloodtransfusions(P<0.0001).Attheendof12thweekaftertransplantation,theincedenceofHCVinfectionreached62.2%,whichwassignificantlyhigherthanthatofgeneralpopulationandpre-operationpatients.ThefrequencyofHCVinfectionwas13.9%(5outof36)incadavericdonors.FourrecipientswithoutHCVinfectionbe-foretransplantation,receivedtherenalgraftsfromHCVinfecteddonors.After12weks,threofthembecameanti-HCVandHCV-RNApositive.ThisresultsindicatedthatahighrateofHCVtransmisionbydonorkidney.Therewasnosignificantdiferenceintheincidencesofacutealograftrejectionbe-tweentheHCV(+)recipientsandHCV(-)recipients(45.2%vs27.8%,P>0.05)duringa12-weekfolow-upaftertransplantation.CONCLUSIONSHCVinfectionisverycommoninhemodialysispatientsandrenaltransplantrecipi-entsinChina.HCVinfectioniscloselyrelatedtolengthoftimeonhemodialysisandtoamountofbloodtransfusionsinpre-transplantationpatients.HCVcanbetransmitedthroughrenalgrafttransplanta-tion.TransaminaselevelcannotbeusedasasurogatemarkerofHCVinfectioninthesepatients.Rou-tinedetectionforbothAnti-HCVandHCV-RNAisimportantandnecessarybeforeandafterrenaltransplantation.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
1996年第6期9-14,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
