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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. -
表 1 HBsAg(+)与HBsAg(-)组肾移植患者肝、肾功能的比较
Table 1. Comparison of liver and renal function in patients with renal transplantation between HBsAg (+) and HBsAg (-) groups (median)
指标 组别 n 术前 术后时间(月) 1 3 6 12 18 24 36 60 ALT
(U/L)HBsAg (+) 组 116 19 25 23 24 24 25 29 28 22 HBsAg (-) 组 348 15 19 18 18 17 17 17 18 18 P值 0.000 0.014 0.000 0.000 0.000 0.000 0.000 0.001 0.203 AST
(U/L)HBsAg (+) 组 116 17 20 24 23 23 24 25 25 23 HBsAg (-) 组 348 13 18 21 20 20 20 20 21 21 P值 0.013 0.004 0.000 0.000 0.001 0.000 0.000 0.002 0.761 Scr
(μmol/L)HBsAg (+) 组 116 991 111 114 113 113 117 114 122 121 HBsAg (-) 组 348 997 112 113 111 110 113 115 113 115 P值 0.435 0.265 0.377 0.391 0.160 0.236 0.798 0.735 0.550 表 2 大三阳与小三阳组肾移植患者肝、肾功能的比较
Table 2. Comparison of liver and renal function in patients with renal transplantation between (HBsAg, HBeAg and anti-HBc positive) and (HBsAg, anti-HBe and anti-HBc positive) groups (median)
指标 组别 n 术前 术后时间(月) 1 3 6 12 18 24 36 60 ALT
(U/L)大三阳组 34 25 29 23 23 21 24 27 23 23 小三阳组 82 24 23 24 25 24 26 29 28 20 P值 0.787 0.218 0.778 0.490 0.870 0.676 0.590 0.459 0.705 AST
(U/L)大三阳组 34 18 21 24 23 22 23 25 24 21 小三阳组 82 16 19 24 24 24 24 25 25 24 P值 0.510 0.235 0.990 0.735 0.738 0.657 0.906 0.633 0.950 Scr
(μmol/L)大三阳组 34 957 111 113 108 117 121 110 123 145 小三阳组 82 999 111 115 115 113 114 117 122 120 P值 0.741 0.865 0.834 0.884 0.366 0.490 0.976 0.540 0.374 表 3 术前HBV DNA(+)与HBV DNA(-)组肾移植患者肝、肾功能的比较
Table 3. Comparison of liver and renal function in patients with renal transplantation between preoperative HBV DNA (+) and HBV DNA (-) groups (median)
指标 组别 n 术前 术后(月) 1 3 6 12 18 24 36 60 ALT
(U/L)HBV DNA (+) 组 39 22 25 30 24 23 23 26 26 30 HBV DNA (-) 组 77 19 25 23 23 24 23 24 25 20 P值 0.198 0.231 0.182 0.400 0.699 0.703 0.681 0.095 0.466 AST
(U/L)HBV DNA (+) 组 39 19 21 27 22 24 25 25 26 27 HBV DNA (-) 组 77 16 19 23 23 23 23 25 24 21 P值 0.242 0.201 0.073 0.733 0.679 0.529 0.537 0.059 0.056 Scr
(μmol/L)HIU DNA (+) 组 39 962.0 110.4 112.7 111.6 116.7 120.7 111.8 140.7 155.7 HBV 1) NA (-) 组 77 999.2 114.9 116.9 114.4 112.8 113.9 114.1 120.9 120.3 P值 0.874 0.650 0.926 0.823 0.363 0.798 0.766 0.360 0.056 表 4 术前肝功能正常与异常的肾移植患者肝、肾功能的比较
Table 4. Comparison of liver and renal function in patients with renal transplantation between preoperative normal and abnormal liver function groups (median)
指标 组别 n 术前 术后(月) 1 3 6 12 18 24 36 60 ALT
(U/L)肝功能正常组 81 17 21 22 22 23 23 26 27 20 肝功能异常组 35 54 38 36 34 38 34 34 33 34 P值 0.000 0.000 0.027 0.003 0.008 0.055 0.191 0.287 0.176 AST
(U/L)肝功能正常组 81 15 19 23 23 23 23 25 25 21 肝功能异常组 35 34 27 26 25 25 24 25 26 26 P值 0.000 0.000 0.069 0.343 0.629 0.996 0.813 0.366 0.295 Scr
(μmol/L)肝功能正常组 81 989.0 111.0 114.0 110.7 112.4 114.3 111.6 118.9 116.7 肝功能异常组 35 992.3 110.9 119.5 125.7 126.0 125.8 129.6 133.0 134.5 P值 0.798 0.949 0.429 0.266 0.081 0.056 0.115 0.063 0.196 -
[1] Reddy PN, Sampaio MS, Kuo HT, et al. Impact of pre-existing hepatitis B infection on the outcomes of kidney transplant recipients in the United States[J]. Clin J Am Soc Nephrol, 2011, 6(6): 1481-1487. DOI: 10.2215/CJN.09201010. [2] Tsai MC, Chen YT, Chien YS, et al. Hepatitis B virus infection and renal transplantation[J]. World J Gastroenterol, 2010, 16(31): 3878-3887. doi: 10.3748/wjg.v16.i31.3878 [3] 刘淑粉, 杨淑玲.乙肝病毒感染者肾移植术后肝功能损害的临床分析和随访管理[J].全科护理, 2015, (17): 1635-1637. DOI: 10.3969/j.issn. 1674-4748. 2015.17.024.Liu SF, Yang SL. Clinical analysis and follow-up management of liver function damage in patients with hepatitis B virus infection after kidney transplantation[J]. Chin Gen Pract Nurs, 2015, (17): 1635-1637.DOI: 10.3969/j.issn.1674-4748.2015.17.024. [4] 石韶华, 王振兴, 陈花, 等.乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者存活的影响[J].器官移植, 2012, 03(3): 159-162.DOI: 10.3969/j.issn.1674-7445.2012.03.008.Shi SH, Wang ZX, Chen H, et al. Influence of hepatitis B virus and hepatitis C virus infection on the survival of renal transplant recipients[J]. Organ Transplant, 2012, 3(3): 159-162.DOI: 10.3969/j.issn.1674-7445.2012.03.008. [5] Emori CT, Perez RM, Matos CA, et al. Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients[J]. Braz J Infect Dis, 2014, 18(6): 625-630. DOI: 10.1016/j.bjid.2014.06.004. [6] Maekawa H, Yazawa M, Koitabashi K, et al. Safety of monitoring viral and liver function markers in patients with prior resolved hepatitis B infection after kidney transplantation[J]. Transplant Proc, 2016, 48(6): 2046-2049. DOI: 10.1016/j.transproceed.2016.03.049. [7] Fabrizi F, Dulai G, Dixit V, et al. Lamivudine for the treatment of hepatitis B virus-related liver disease after renal transplantation: meta-analysis of clinical trials[J]. Transplantation, 2004, 77(6): 859-864. doi: 10.1097/01.TP.0000116448.97841.6D [8] 刘勇, 杨亦荣, 郑少玲, 等.145例肾移植受者死亡原因分析[J].中华器官移植杂志, 2004, 25(4): 235-236. DOI: 10.3760/cma.j.issn.0254-1785.2004.04.015.Liu Y, Yang YR, Zheng SL, et al. Analysis of the death causes of 145 cases of renal transplant recipients[J]. Chin J Organ Transplant, 2004, 25(4): 235-236. DOI: 10.3760/cma.j.issn.0254-1785.2004.04.015. [9] Chan TM, Fang GX, Tang CS, et al. Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients[J]. Hepatology, 2002, 36(5): 1246-1252. doi: 10.1053/jhep.2002.36156 [10] Grenha V, Parada B, Ferreira C, et al. Hepatitis B virus, hepatitis C virus, and kidney transplant acute rejection and survival[J]. Transplant Proc, 2015, 47(4): 942-945. DOI: 10.1016/j.transproceed.2015.04.004. [11] Tuncer M, Tekin S, Yücetin L, et al. Hepatitis B surface antigen positivity is not a contraindication for living kidney donation[J]. Transplant Proc, 2012, 44(6): 1628-1629. DOI: 10.1016/j.transproceed.2012.04.015. [12] Lee J, Cho JH, Lee JS, et al. Pretransplant hepatitis B viral infection increases risk of death after kidney transplantation: a multicenter cohort study in korea[J]. Medicine (Baltimore), 2016, 95(21): e3671. DOI: 10.1097/MD.0000000000003671. [13] 韩国锋, 胡大勇, 顾勇, 等.乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者长期预后影响[J].中国临床医学, 2009, 16(3): 406-409. DOI: 10.3969/j.issn.1008-6358.2009.03.030.Han GF, Hu DY, Gu Y, et al. Impact of hepatitis B and hepatitis C virus infections on patients and allograft outcomes in renal transplant recipients[J]. Chin J Clin Med, 2009, 16(3): 406-409. DOI: 10.3969/j.issn.1008-6358.2009.03.030. [14] Kliem V, Burg M, Haller H, et al. Relationship of hepatitis B or C virus prevalences, risk factors, and outcomes in renal transplant recipients: analysis of German data[J]. Transplant Proc, 2008, 40(4): 909-914. DOI: 10.1016/j.transproceed.2008.03.031. [15] 汪东剑, 张晓云, 李志晋, 等. HBV-DNA与乙型肝炎血清标志物的相关性分析[J].现代生物医学进展, 2014, 14(3): 444-447. DOI: 10.13241/j.cnki.pmb. 2014.03.012.Wang DJ, Zhang XY, Li ZJ, et al. Analysis of the correlation between serum immune markers of hepatitis B virus and HBV-DNA[J]. Progr Mod Biomed, 2014, 14(3): 444-447. DOI: 10.13241/j.cnki.pmb.2014.03.012. [16] 许龙根, 成军, 宋启哲, 等.血清乙型肝炎病毒标志物不同表现模式及肝功能异常对肾移植受者存活率的影响[J].中华器官移植杂志, 2002, 23(5): 281-283. DOI: 10.3760/cma.j.issn.0254-1785.2002.05.008.Xu LG, Cheng J, Song QZ, et al. Effect of varied Modes of serum hepatitis virus markers and liver dysfunction on the survival rate of the renal transplant recipients[J]. Chin J Organ Transplant, 2002, 23(5): 281-283. DOI: 10.3760/cma.j.issn.0254-1785.2002.05.008. [17] 童强, 姚立欣, 羊继平, 等.肝炎病毒阳性患者肾移植术后肝损害的临床研究[J].东南国防医药, 2008, 10(2): 93-96. http://www.cnki.com.cn/Article/CJFDTOTAL-DNGY200802006.htmTong Q, Yao LX, Yang JP, et al. Clinical research on the liver damage in the patients with viral hepatitis after renal transplantation[J]. Milit Med J Southeast Chin, 2008, 10(2): 93-96. http://www.cnki.com.cn/Article/CJFDTOTAL-DNGY200802006.htm [18] 王庆文, 季曙明.慢性肝炎受者肾移植术前肝活检的临床价值[J].肾脏病与透析肾移植杂志, 2000, 9(3): 210-214. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200003002.htmWang QW, Ji SM. Liver biopsy in candidate renal graft recipients with chronic hepatitis[J]. Chin J Nephrol Dial Transpl, 2000, 9(3): 210-214. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200003002.htm [19] 丁振山, 杨志豪.肾移植患者感染乙肝病毒的抗病毒治疗[J].肾脏病与透析肾移植杂志, 2010, 19(1): 84-87.DOI: 10.3969/j.issn.1006-298X.2010.01.018.Ding ZS, Yang ZH. Antiviral treatment of hepatitis B virus infection in patients with renal transplantation[J]. Chin J Nephrol Dial Transpl, 2010, 19(1): 84-87. DOI: 10.3969/j.issn.1006-298X.2010.01.018.
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