Lamivudine therapy in kidney allograft recipients who are seropositive for hepatitis B surface antigen

BACKGROUND: There are numerous recent reports on the use of lamivudine for hepatitis B virus (HBV) infection after renal transplantation. However, the optimal strategy (prophylactic, preemptive, or salvage approach) for starting lamivudine treatment in this patient group has not been determined. The aim of this study was to assess how the timing of lamivudine therapy affected the HBV serological status and the transaminase levels in renal allograft recipients with chronic HBV infection. METHODS: We investigated outcomes for patients who were seropositive for hepatitis B surface antigen (HBsAg) and underwent transplantation before or after October 2004 (the date our institution implemented a prophylactic lamivudine treatment strategy against HBV). The data included serum liver enzyme levels and polymerase chain reaction (PCR) screening results for HBV-DNA in serum. RESULTS: Fifteen patients (11 before October 2004, four after October 2004) were included in the study. Preoperatively all patients had normal transaminases levels and 2 of 15 patients had detectable HBV-DNA on PCR. Eight of the 15 total HBsAg-positive patients in our series were not placed on lamivudine at the time of renal transplantation. Half of those who were not treated initially showed transaminase elevations in the first year of follow-up requiring lamivudine therapy at that time. In contrast, all seven individuals who received lamivudine at the time of transplantation were negative for HBV-DNA throughout the follow-up. CONCLUSION: To prevent viral replication in HBsAg-positive patients who are scheduled for renal transplantation, it is best to initiate lamivudine therapy before or immediately after transplantation.     

慢性乙型肝炎患者病毒e系统状态与肝纤维化关系的研究

目的:观察慢性乙型肝炎患者乙型肝炎病毒e系统状态和复制指标在肝纤维化发生过程中的变化及其与血清纤维化标志的关系,探讨它们在肝纤维化发生过程中的作用及其可能的临床意义.方法:188例慢性乙型肝炎患者根据肝纤维化程度分为S0～S4期等5组,分别用定量PCR及放免法检测患者血清中HBV-DNA及肝纤维化标志透明质酸、Ⅳ型胶原、Ⅲ型前胶原和层粘连蛋白的含量;HBeAg和抗-HBe采用酶联免疫吸附法(ELISA)检测,并观察其在不同肝病理纤维化分期时的变化.结果:随着肝纤维化程度加重,血清HBV-DNA含量逐渐升高,从S1期开始显著增加(P＜0.01);而HBeAg阳性率逐渐降低,S3、S4期较S0显著减少(P＜0.05和P＜0.01);抗-HBe阳性率呈相反的变化趋势,在S3和S4期的阳性率明显高于S0期(P＜0.05和P＜0.01).血清HBV-DNA( )HBeAg( )组血清纤维化标志最低,HBV-DNA(-)抗-HBe( )组最高,两者差异有显著性(P＜0.01).结论:HBV复制和e系统状态的改变与肝纤维化程度密切相关,肝内病毒复制标志与血清纤维化标志联合检测,对于判断肝纤维化程度和指导抗病毒治疗有重要的价值.     

乙型肝炎病毒相关膜性肾病患者抗血清磷脂酶A2受体-IgG特点及其相关因素的临床研究

目的研究乙型肝炎病毒相关膜性肾病(HBV-MN)患者血清抗磷脂酶A2受体(PLA2R)-IgG阳性率,分析与PLA2R-IgG滴度相关的因素。 方法本研究纳入经肾穿刺活检确诊的HBV-MN患者108例,检测血清PLA2R－IgG滴度、肌酐、白蛋白和24 h尿蛋白定量等,计算肾小球滤过率,分别统计患者肾活检组织中PLA2R及免疫荧光IgG、C3、C1q及IgG亚型阳性率,分析年龄、性别、蛋白尿与血清中和肾活检组织中PLA2R-IgG检测结果的关系。 结果108例HBV-MN患者中,血清PLA2R-IgG阳性率为37%,肾组织PLA2R阳性率54.6%,血清PLA2R-IgG的阳性率和滴度与年龄、性别无统计学相关性(P>0.05),与尿蛋白水平相关(χ²＝9.159,P＝0.010;χ²＝11.327,P＝0.004);尿蛋白>3.5 g/d组患者PLA2R－IgG阳性率显著高于尿蛋白<1g/d及1～3.5 g/d组(Z＝2.863,P＝0.012和Z＝2.356,P＝0.049)。 结论HBV-MN患者中PLA2R-IgG阳性率较高,阳性率及滴度均与蛋白尿水平相关,尿蛋白越多,阳性率和滴度也随之升高。     

Clinical and virological effects during two years of ongoing adefovir dipivoxil in the treatment of lamivudine-resistant chronic hepatitis B infection

OBJECTIVE: Our aim was to evaluate the efficacy and safety of adding adefovir to lamivudine therapy for hepatitis B virus (HBV)-infected patients resistant to Ramivudine. PATIENTS AND METHODS: Among 17 studied patients, 7 had chronic active HBV infection and 10 were posttransplant with HBV infection (9 with de novo HBV). They received lamivudine plus adefovir therapy for 2 years. We assessed reductions in serum HBV-DNA and alanine aminotransferase (ALT) levels, loss of HBeAg (in HBeAg+ cases), and HBsAg clearance. RESULTS: A virological response, as defined by HBV-DNA below the cut off by hybridization, was observed in 12 (70.6%) patients and loss of HBeAg in 4 (44.4%) of the 9 initially HBeAg-positive cases. A biochemical response, defined as a decreased serum ALT to the normal range, occurred in 4 (26.7%) patients. Median serum creatinine increased in 3 of 15 (20%) patients, excluding those on hemodialysis. There were two noteworthy cases of sustained HBsAg seroconversion with adefovir (11.8%): one patient with de novo HBV infection posttransplantation and positive hepatitis C virus-RNA serology, and one patient with decompensated HBV cirrhosis in whom viral replication ceased, making him eligible for transplantation. CONCLUSIONS: Currently, adefovir is an effective rescue therapy that broadens the existing range of options for patients with lamivudine-resistant chronic hepatitis B infection, particularly those with decompensated cirrhosis awaiting a liver graft, and those with recurrent posttransplantation HBV. The relatively small biochemical response seen in these patients may be attributable to the high prevalence of concomitant hepatitis C virus infection (41%).     

Membranous glomerulonephritis associated with hepatitis B antigen in children: a comparison with idiopathic membranous glomerulonephritis

The laboratory and pathological findings are reported for 16 children with membranous glomerulonephritis (MGN) associated with hepatitis B virus (HBV) infection and compared with those of 12 children with idiopathic MGN. Serum hepatitis B surface antigen (HBsAg) was found in all children with HBV associated MGN and serum hepatitis B e antigen (HBeAg) in 11 of the 15 examined. Five patients with HBV associated MGN, but none with idiopathic MGN, showed reduced serum C3 values. Otherwise there was no difference in laboratory findings. HBeAg was detected in the glomeruli of all 7 patients with HBV-associated MGN examined but HBsAg was not detected. Of the 14 children with HBV-associated MGN examined by electron microscopy, all but one showed small mesangial deposits and 4 subendothelial deposits, whereas of 9 with idiopathic MGN only 2 showed mesangial deposits and none subendothelial deposits. Thus most of the children with HBV-associated MGN are characterized by some laboratory and pathological features of membrano proliferative glomerulonephritis in addition to those of idiopathic MGN. These observations are consistent with HBV inducing a spectrum of glomerulopathy from typical MGN to typical membranoproliferative glomerulonephritis.     

乙型肝炎患者外周血中IL-6和sIL-2R含量变化及其意义

目的探讨细胞因子IL-6和sIL-2R在乙型肝炎病毒感染后的免疫应答中所起作用和临床意义。方法使用ELISA定量检测75例乙型肝炎患者和15例健康对照的血浆IL-6和sIL-2R含量。结果急性乙型肝炎患者组血浆IL-6和sIL-2R含量明显高于健康对照组;在慢性乙型肝炎中,随着病情加重,血浆IL-6和sIL-2R含量随之升高,特别是轻度组及中度组与重度组间存在显著性差异(P<0.05);在ALT正常组与ALT异常组之间比较发现,ALT异常组的血浆IL-6和sIL-2R含量明显高于ALT正常组(P<0.05,P<0.01)。结论乙肝患者机体存在免疫应答异常导致免疫损伤,IL-6和sIL-2R含量变化能部分反映机体肝细胞损伤情况和损伤机制。     

恩替卡韦治疗乙型肝炎病毒相关性肾炎的疗效观察

目的 探讨恩替卡韦（ETV）治疗不同内生肌酐清除率（Ccr）的乙型肝炎病毒相关性肾炎（HBV-GN）患者的疗效及安全性.方法 连续收集2006年7月至2012年1月无锡市第五人民医院的108例HBV-GN患者.根据Ccr将患者分成A组32例（≥80 mL/min）,B组31例（50～＜80 mL/min）,C组25例（30 ～ ＜50 mL/min）,D组20例（＜30 mL/min）.4组均在常规治疗的基础上分别加用ETV 0.5,0.5,0.25和0.15 mg/d治疗,疗程均为52周.采用x2检验或确切概率法比较治疗52周后4组间生化学、病毒学和血清学应答率以及肾功能、Ccr和24 h尿蛋白定量改善情况.结果 治疗52周时,4组患者ALT和HBV DNA水平均较治疗前明显下降（P＜0.05）,且4组间ALT复常率、HBV DNA ＜500拷贝/mL患者的比例,以及HBeAg转阴或血清学转换率比较差异无统计学意义（x2=0.654,1.644和0.094,P＞0.05）.治疗52周时,B、C、D组患者尿素氮（BUN）改善比例分别为32.3％,8.0％和5.0％,血肌酐（Scr）改善比例分别为25.8％,4.0％和0,Ccr改善比例分别为25.8％,4.0％和0,B组与C组、D组比较差异均有统计学意义（P＜0.05）;4组24 h尿蛋白定量较治疗前下降的比例分别为53.1％,41.9％,8.0％和0,A组、B组与C组、D组比较差异均有统计学意义（P＜0.05）.4组患者均未见与服用ETV相关的严重不良反应.结论 ETV治疗可有效改善HBV-GN患者的肝功能,且病毒学和血清学应答情况良好,其中Ccr≥50 mL/min的患者肾功能及24 h尿蛋白定量水平也可获得部分改善.     

恩替卡韦联合糖皮质激素治疗乙肝病毒相关性肾炎的临床观察

目的观察恩替卡韦联合糖皮质激素治疗乙型肝炎（乙肝）病毒相关性肾炎的临床效果。方法选取在我院住院的乙肝病毒相关性肾炎患者65例,将患者随机分成2组。单一抗病毒组30例,单用恩替卡韦抗病毒治疗。联合治疗组35例,恩替卡韦抗病毒联合适量、短期糖皮质激素治疗。2组均给予常规护肝、降酶及保护肾功能治疗。对所有患者治疗前、后乙肝病毒DNA、肝功能、肾功能、血尿常规进行测定。结果在抗病毒、护肝方面,治疗12个月后,2组血清乙肝病毒DNA载量及丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平下降幅度均无明显差异。但较之单一治疗组,联合治疗组治疗3～6个月时乙肝病毒DNA载量下降延迟,治疗12个月后乙肝病毒e抗原／e抗体血清学转换率降低。在降尿蛋白、护肾方面,较之单一治疗组,治疗3～6个月时,联合治疗组24h尿蛋白定量减少及血清白蛋白升高幅度均有明显优势。治疗12个月后,总有效率显著提高。结论较之单用恩替卡韦抗病毒治疗,恩替卡韦联合适量、短期糖皮质激素治疗可显著降低乙肝病毒相关性肾炎患者的尿蛋白,升高血清白蛋白,提高总有效率,且对恩替卡韦抑制乙肝病毒复制的效果及由此产生的护肝作用无明显影响。     

抗乙肝病毒联合免疫抑制剂治疗HBsAg阳性、HBV—DNA复制的乙肝相关性膜性肾病

目的：探讨抗乙肝病毒联合免疫抑制剂方案治疗HBsAg阳性、HBV—DNA复制的乙肝相关性膜性肾病（HBV—MN）的疗效和安全性。方法：回顾性收集经肾活检确诊并住院治疗和随访的20例HBV—MN成人患者,分成乙肝活动组（10例）和无乙肝活动组（10例）,血清FnBsAg阳性、HBV—DNA〉1000拷贝／ml的HBV—MN患者称乙肝活动组,接受抗乙肝病毒联合免疫抑制剂加ACEI和／或ARB治疗;血清HBsAg阴性、HBV—DNA〈1000拷贝／ml的HBV—MN患者称无乙肝活动组,仅接受免疫抑制剂加ACEI／ARB治疗,对两组患者进行临床表现、病理特征、治疗缓解率、副反应发生率的回顾性对比分析。结果：（1）乙肝活动组伴有高血压3例（30％）,无乙肝活动组伴有高血压6例（60％）,两组患者均有浮肿和血尿;谷丙转氨酶（ALT）、谷草转氨酶（AST）、血白蛋白（Alb）、24h尿蛋白定量、血肌酐（Scr）和肾小球滤过率（GFR）两组之间差异均无统计学意义（P〉0．05）。（2）两组病例光镜和电镜下表现均无差异;肾组织免疫荧光显示免疫球蛋白和补体沉积均在3种及以上,两组间C1q和纤维蛋白原沉积比例差异无统计学意义。（3）乙肝活动组完全缓解率60％,总缓解率100％,平均缓解时间13．7个月;无乙肝活动组完全缓解率70％,总缓解率90％,平均缓解时间13．2个月。（4）治疗副反应：乙肝活动组1例出现血HBV～DNA升高,1例出现肝酶升高;无乙肝活动组2例出现肝酶升高,减药物剂量后肝酶恢复正常,两组均未发现严重不良反应。结论：HBV—MN患者的肾脏损害程度并不取决于血中乙肝病毒的活跃程度;HBV—MN治疗应遵循个体化原则,若血中乙肝病毒复制者,在严密监测情况下,抗乙肝病毒联合激素或／和免疫抑制剂治疗可能是一种对疾病有益的尝试。     

Limited lamivudine and long-term hepatitis B immunoglobulin immunoprophylaxis for prevention of hepatitis B recurrence after liver transplantation

BACKGROUND: No consensus exists concerning dosage and duration of prophylactic hepatitis B immunoglobulin and lamivudine for prevention of hepatitis B recurrence after liver transplantation (LT). METHODS: Lamivudine was discontinued 12 months after LT, maintaining hepatitis B immunoglobulin prophylaxis in eight patients who received lamivudine treatment before LT. RESULTS: At LT, six patients were serum hepatitis B virus (HBV)-DNA negative, whereas two patients had low serum HBV-DNA levels. Hepatitis B surface (HBs) antigen and hepatitis B core antigen stained positively by immunohistochemistry in all hepatectomy specimens. All patients remained recurrence free during the 12 months on combination therapy with normal liver histological examination and negative HBs and HB core staining on biopsy specimens. No relapse occurred after lamivudine withdrawal during a median follow-up of 17.5 months (normal transaminases, negative serum HBs antigen, and HBV-DNA). CONCLUSIONS: Discontinuation of lamivudine 12 months after LT is feasible and safe even in patients with ongoing low viral replication at LT, providing adequate prophylaxis with hepatitis B immunoglobulins.     

Liver function in patients with mild alcoholic hepatitis, after enflurane, nitrous oxide-narcotic, and spinal anesthesia

The effects of three anesthetic techniques on liver function were compared in patients with mild alcoholic hepatitis who required surgery, both peripheral and superficial. Thirty patients were randomly assigned to receive one of three anesthetics: thiopental, nitrous oxide and oxygen, enflurane, plus muscle relaxant; thiopental, nitrous oxide and oxygen, narcotic, plus muscle relaxant; or spinal anesthesia with tetracaine. Measurements of hepatic function were made preoperatively (on the day of operation) and on the first and third postoperative days. Levels of serum bilirubin, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and lactate dehydrogenase liver isoenzyme were similar in the three groups on both postoperative days. They were not significantly different from those obtained preoperatively, although mean values decreased by the first postoperative day and again on the third. The data suggest that the choice among the three anesthetic methods studied could be based on factors other than the presence of mild alcoholic hepatitis and that, when peripheral surgery is required, one may not anticipate a worsening of any biochemical disorder in the first three postoperative days.     

恩替卡韦联合介入治疗乙型肝炎相关原发性肝癌的临床研究

目的：探讨恩替卡韦联合介入方法治疗乙型肝炎相关原发性肝癌（HBVR-HCC）的临床疗效。 方法：选择2007年2月—2011年2月85例确诊为HBVR-HCC、没有手术治疗适应证的患者,其中44例采用恩替卡韦联合肝动脉段性化疗栓塞（TACE）治疗（观察组）,41例单纯采用TACE治疗（对照组）,分析两组治疗前和治疗后4、12、24、48周HBV-DNA水平、肝功能、AFP水平和Child-Pugh评分,并比较两组的临床疗效、不良反应以及生存状况。 结果：随治疗时间延长,观察组HBV-DNA水平逐渐降低,而对照组逐渐升高,两组差异在治疗后各时间点均有统计学意义（均P<0.05）;两组谷丙转氨酶（ALT）与AFP水平、逐渐降低,但观察组在治疗24周后的降低程度明显优于对照组（均P<0.05）;两组Child-Pugh评分逐渐升高,但观察组在治疗24周后的升高程度低于对照组（P<0.05）。观察组HCC的治疗有效率明显高于对照组,并发症和不良反应均明显低于对照组（均P<0.05）。两组的1年生存率的差异无统计学意义（P>0.05）,但观察组2年生存率和中位生存期优于对照组（均P<0.05）。 结论：TACE对HBV活动存在激发作用,抗病毒联合TACE治疗HBVR-HCC可有效控制HBV,改善患者的肝功能,提高临床疗效,且不增加毒副作用。     

Safety and efficacy of mizoribine treatment in nephrotic syndrome complicated with hepatitis B virus infection: a clinical study

Objective The objective of this study is to explore the efficacy and safety of mizoribine (MZR) in treating nephrotic syndrome patients afflicted with hepatitis B virus (HBV). Methods The present study included 36 nephrotic syndrome patients accompanied with HBV infection. A draft of MZR (150–200?mg/d), methylprednisolone (0.6–0.8?mg/kg·d), and entecavir (0.5?mg/d) was administered to study patients over 24 weeks. The serum albumin (AlB), 24-h urine protein (24-U-TP), liver and renal functions, and HBV-DNA were quantified before and at 2, 4, 8, 12, 16, 20, and 24 weeks after the treatment. The adverse responses were recorded. Results The AlB levels of patients increased gradually after comprehensive treatment, while the 24-U-TP, serum cholesterol, and triglyceride (TG) levels declined gradually. The changes at 24 weeks post-treatment were statistically significant. Compared with the levels before treatment, the HBV-DNA, transaminase, and renal functions of the patients were not significantly altered after the treatment. No evident adverse response was found. Conclusion Treatment using MZR in combination with methylprednisolone and entecavir in HBV-positive nephrotic syndrome patients displays significant efficacy with a low incidence of adverse reactions.     

Clinical features, pathogenesis and treatment of hepatitis B virus-associated membranous nephropathy in children

Summary: Membranous nephropathy (MN) is the commonest named lesion associated with hepatitis B virus (HBV) infection in Taiwanese children. This review focuses on the clinical features, the pathogenesis and immune abnormality and possible treatment of HBV-MN.     

血清miRNA-122检测在乙型病毒肝炎及晚期肝纤维化患者中的临床意义

[摘 要] 目的 探索血清miRNA-122在乙型病毒肝炎及晚期肝纤维化患者中的表达及其临床意义。方法采用前瞻性非随机对照法,选取2014 年3 月至2016 年6 月在宝鸡市人民医院进行肝穿刺活检的乙型肝炎患者320 例和健康对照者310 例。参照2010 年病毒性肝炎防治方案进行纤维化分期。RT-qPCR法检测血清miRNA122,ROC分析miRNA-122 对乙肝患者肝纤维化程度的预测价值。结果 320 例乙肝患者纤维化分期S0-1 者98 例,S2 者82 例,S3 者66 例,S4 者74 例。健康对照者血清miRNA-122（1.00±0.09）显著低于S0-1（4.76±1.13,t=21.52,P<0.001）、S2（3.97±0.85,t=22.43,P<0.001）、S3（2.83±0.56,t=20.72,P<0.001）和S4（2.48±0.41,t=22.34,P<0.001）组乙肝患者。血清miR122与肝纤维化分期（S0,1,2,3,4）呈负相关（r=-0.328,P=0.033）。AST、HBV-DNA、ALB、PLT、FIB-4、APRI、miRNA-122是乙肝患者晚期肝纤维化的独立危险因素。血清miRNA-122 对不同肝纤维化程度乙肝患者的预测价值能效较好（P<0.05）,尤其是晚期纤维化组（S3+S4 组）和肝硬化组（S4 组）能效更佳（AUC>0.700,敏感性和特异性均>70%,P<0.05）。结论 血清miRNA-122可作为乙肝患者无创纤维化评价指标,尤其是针对晚期纤维化乙肝患者。     

Can hepatitis B core antibody positive livers be used safely for transplantation: hepatitis B virus detection in the liver of individuals who are hepatitis B core antibody positive.

A major impediment to the wider application of clinical liver transplantation is the paucity of acceptable organs. Most centers refuse organs that come from donors who are hepatitis B core antibody positive because of a fear of transmission of hepatitis B virus (HBV) infection to the recipient. The risk related to the use of such donor organs has never been assessed in an ordered manner. The presence or absence of polymerase chain reaction detectable HBV-DNA in liver tissue of individuals undergoing liver biopsy for clinical reasons was assessed in 133 consecutive patients. A total of 8.2% of these livers resulted positive for HBV-DNA; interestingly the rate was higher among those who were hepatitis B surface antibody positive (12.5%) as compared to those without detectable hepatitis B surface antibody (5.7%). These data provide measures of putative risk for HBV infection in liver transplant recipients associated with the use of organs obtained from a hepatitis B core antibody positive donor.     

Bone mineral density and bone turnover in non-cirrhotic patients with chronic hepatitis C and sustained virological response to antiviral therapy with peginterferon-alfa and ribavirin

Summary

Patients with chronic hepatitis C have low bone mineral density and increased bone resorption related to serum transaminase levels. Elevated serum soluble tumor necrosis factor (sTNFR-55) receptor levels may play a role in the bone mass loss in these patients. Bone mass is improved and bone turnover normalized in patients who respond to antiviral therapy with interferon and ribavirin.

Introduction

Low bone mineral density (BMD) has been described in patients with chronic hepatitis C (HCV). The study objective was to evaluate the effect of antiviral therapy on BMD and bone metabolism in non-cirrhotic HCV patients with sustained virological response.

Methods

We conducted a prospective study in 36 consecutive outpatients from the general community with non-cirrhotic HCV and an early and sustained virological response to peginterferon-alfa and ribavirin therapy. Determinations of BMD (dual X-ray absorptiometry at lumbar spine and femoral neck) and biochemical measurements of bone metabolism and sTNFR-55 were made at baseline, after 24 and 48 weeks of antiviral therapy, and at 48 weeks after the end of treatment.

Results

Patients had a significantly reduced BMD, which significantly increased during the follow-up. Serum levels of sTNFR-55 and bone turnover markers were increased at baseline and significantly reduced at all subsequent time points. We found an inverse correlation between BMD and both serum aminotransferase levels and urine deoxypyridinoline (D-pyr) and a positive correlation between serum aminotransferases and both urine D-Pyr and serum sTNFR-55.

Conclusions

Patients with chronic hepatitis C have low bone mass associated with increased bone resorption, and some relationship can be expected between serum aminotransferase levels and the degree of bone mass loss. Bone mass may be improved and bone turnover normalized in patients who respond to antiviral therapy. Elevated serum sTRFR-55 levels may play a role in the bone mass loss of these patients.     

Leukopenia and thrombocytopenia in hemodialysis patients with hepatitis B or C virus infection and non-hemodialysis patients with hepatitis cirrhosis

AIMS: To investigate the relation of leukopenia and thrombocytopenia in hemodialysis (HD) patients with hepatitis C virus (HCV) infection. MATERIALS AND METHODS: The study included 86 HD patients with hepatitis B surface antigen-negative and hepatitis C antibody-negative, 28 HD patients with hepatitis C antibody-positive, 22 HD patients with hepatitis B surface antigen-positive, 78 non-HD patients with hepatitis B-induced liver cirrhosis and 38 non-hemodialysis patients with hepatitis C-induced liver cirrhosis. The following parameters were checked: anti-HCV, hepatitis B surface antigen, hemoglobin, hematocrit, white blood cells, platelets, calcium, phosphate, iron, ferritin, albumin, globulin, aspartate transaminase (AST), alanine transaminase (ALT) and C-reactive protein. The history of blood transfusions, medications, erythropoietin doses and adequate dialysis (KTNV) for 6 consecutive months was also recorded from charts. RESULTS: The HD patients with positive serum anti-HCV and non-HD patients with hepatitis B- or C-induced liver cirrhosis had higher prevalences of leukopenia (39.3%, 43.6% and 50% vs. 15.1%; p < 0.001) and thrombocytopenia (67.9%, 89.7% and 81.6% vs. 34.9%: p < 0.001) than HD patients with serum anti-HCV(-)HbsAg(-). The WBC (4,432 +/- 1,394, 4,792 +/- 2,263 and 4,624 2,446 vs. 5,590 +/- 1,500/mm3; p < 0.001) and platelet counts (140 +/- 45, 80 +/- 50 and 89 +/- 65 vs. 186 +/- 62 x 10(3)/mm3; p < 0.001) of HD patients with positive serum anti-HCV and non-HD patients with hepatitis B- or C-induced cirrhosis were also lower than HD patients without anti-HCV antibody. The liver cirrhosis patients had more thrombocytopenia than the HD patients with anti-HCV(+). The WBC and platelet counts did not vary between HD patients with HbsAg(+) and HD patients with anti-HCV(-)HBsAg(-). The durations of HD, hepatitis and liver cirrhosis were not related to the leukopenia or thrombocytopenia (p > 0.05). CONCLUSIONS: HCV infection associated with leukopenia and/or thrombocytopenia in HD patients is as common as in non-HD patients with liver cirrhosis. This may be due to the direct effect of hemopoiesis rather than the hyperspleenism of liver cirrhosis patients. There is a need for further prospective investigation to ascertain the clinical significance of leukopenia and thrombocytopenia in HD patients with anti-HCV(+). The prevalence of leukopenia and thrombocytopenia was higher in HD patients with hepatitis C than in HD patients with hepatitis B and HD patient without hepatitis.