乙型肝炎病毒携带者肾移植术后临床观察

Clinical observation of hepatitis B virus carriers after renal transplantation

  • 摘要:
      目的  探讨乙型肝炎病毒(HBV)携带者肾移植术后肝、肾功能变化的特点。
      方法  以116例HBV感染肾移植患者及348例同期无HBV感染肾移植患者为研究对象,收集患者术前及术后1、3、6、12、18、24、36、60个月的肝功能丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)、肾功能血清肌酐(Scr)指标。比较乙型肝炎表面抗原(HBsAg)(+)与HBsAg(-)组肾移植患者术前和术后肝、肾功能的变化;根据术前乙型肝炎病毒血清学、术前HBV DNA定量、术前肝功能检查结果,分别将116例HBsAg(+)肾移植患者再分为大三阳组与小三阳组、HBV DNA(+)组与HBV DNA(-)组、术前肝功能正常组与异常组,比较不同亚组间肾移植患者术前和术后肝、肾功能的变化。
      结果  (1)术前HBsAg(+)组患者的ALT、AST均高于HBsAg(-)组,肾移植术后36个月内,两组患者的肝功能比较,差异均有统计学意义(均为P<0.05),但术后60个月两组患者的肝功能比较,差异无统计学意义(均为P>0.05)。HBsAg(+)与HBsAg(-)组肾移植患者术前和术后60个月内的Scr比较,差异均无统计学意义(均为P>0.05)。(2)大三阳组与小三阳组及HBV DNA(+)组与HBV DNA(-)组肾移植患者术前和术后60个月内的肝、肾功能比较,差异均无统计学意义(均为P>0.05)。(3)术前肝功能正常组与异常组肾移植患者术前和术后1、3、6、12个月的ALT比较,差异均有统计学意义(均为P<0.05),两组患者术后其他时间点的ALT比较,差异无统计学意义(均为P>0.05);肾移植术前和术后1个月,两组患者的AST比较,差异均有统计学意义(均为P<0.05),两组患者术后其他时间点的AST比较,差异无统计学意义(均为P>0.05)。两组肾移植患者术前和术后60个月内肾功能比较,差异均无统计学意义(均为P>0.05)。
      结论  HBV感染对肾移植患者术后5年内的肾功能不会有显著影响,但会影响术后短期肝功能。

     

    Abstract:
      Objective  To observe the changes of liver and kidney function in hepatitis B virus (HBV) carriers after renal transplantation.
      Methods  A total of 116 patients with HBV infection undergoing renal transplantation and 348 counterparts without HBV infection were recruited in this clinical trial. The liver function parameters including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and renal function parameter including serum creatinine (Scr) level were measured before and at 1, 3, 6, 12, 18, 24, 36 and 60 months after renal transplantation. Preoperative and postoperative changes of liver and kidney function were statistically compared between the hepatitis B surface antigen (HBsAg) (+) and HBsAg (-) groups. According to the results of preoperative HBV serology, preoperative quantitative detection of HBV DNA and preoperative liver function test, 116 HBsAg (+) patients undergoing renal transplantation were divided into (HBsAg, HBeAg and anti-HBc all positive) and (HBsAg, anti-HBe and anti-HBc all positive) groups, HBV DNA (+) and HBV DNA (-) groups, and normal and abnormal liver function groups. Preoperative and postoperative changes of liver and kidney function were statistically compared between different subgroups.
      Results  (1) Preoperative ALT and AST levels in HBsAg (+) patients were significantly higher compared with those in their HBsAg (-) counterparts. In 36 months after renal transplantation, liver function parameters significantly differed between two groups (all P < 0.05), whereas no statistical significance was noted at postoperative 60 months (all P>0.05). Before and in 60 months after renal transplantation, no statistical significance was observed in the Scr levels between the HBsAg (+) and HBsAg (-) groups (all P>0.05). (2) Before and in 60 months after renal transplantation, no statistical significance was observed in the liver and kidney function parameters between the (HBsAg, HBeAg and anti-HBc all positive) and (HBsAg, anti-HBe and anti-HBc all positive) groups, and HBV DNA (+) and HBV DNA (-) groups (all P>0.05). (3) The ALT levels before and at 1, 3, 6 and 12 months after renal transplantation significantly differed between the normal and abnormal liver function groups (all P < 0.05), whereas no statistical significance was observed at other time points (all P>0.05). The AST levels before and at 1 month after renal transplantation significantly differed between two groups (both P < 0.05), whereas did not significantly differ at alternative postoperative time points (all P>0.05). No statistical significance was observed in the kidney function parameters before and at 60 months following renal transplantation between two groups (all P>0.05).
      Conclusions  HBV infection cannot exert significant effect upon kidney function within 5 years after renal transplantation, whereas it can affect short-term postoperative liver function.

     

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