肝炎病毒阳性患者肾移植术后肝损害的临床研究

目的分析肝炎病毒感染对肾移植术后肝损害的影响,以探讨治疗病毒性肝损害的可行办法。方法回顾性分析肾移植后发生肝损伤者的临床资料,36例术前肝炎病毒感染者作为阳性组,同期无病毒感染者116例为阴性组。术后均采用三联免疫抑制方案,同时监测肝功能、HBV-DNA、HCV-RNA及CsA药物浓度,对肝功能异常者停用C sA改用FK 506,并行保肝治疗,HBV-DNA（＋）者加用拉米夫定抗病毒治疗。结果不同肝炎病毒感染者术后肝损害发病率均高于无病毒感染者,表明对此类患者肾移植后要注意其肝损害的发生。结论术前应对肾移植受者的肝脏情况进行严格的综合评估,肝炎病毒携带者接受肾移植后,出现肝功能异常时,应正确区分系药物性肝损害还是病毒性肝损害,及时采取相应处理,并给予护肝治疗,FK 506替代CsA治疗肾移植术后肝损害患者副作用小,效果好。

Clinical research on the liver damage in the patients with viral hepatitis after renal transplantation

Objective To analyze the influence of hepatic virus infection on the liver damage of recipients with renal allograft, and to explore the treatment for the viral liver damage. Methods The clinical data were analyzed retrospectively. 36 cases with the infection of hepatitis virus before operation were divided into positive group, and 116 cases without infection before operation were as negative control. All patients were treated with the similar immunosuppressive agents and liver protective medicine after operation. The liver function test, HBV DNA, HCV-RNA and the concentration of CsA were monitored. CsA was replaced with FK506 to the patients with abnormal liver function. Lamivudine was added to the treatment for the patients with HBV-DNA positive. Results The incidence rate of liver damage in the patients with different hepatitis virus infection was significantly higher than in those without infection. Our data showed that the liver damage of renal allograft patients with virus infection should be paid more attention. Conclusion The strict evaluation of liver function should be subjected to renal allograft recipients before operation. The liver damage of patients with virus infection should be diagnosed correctly, and be treated with protective drug for liver. The side effect on treatment for liver damage of renal allograft patients is little when CsA replaced by FK506.