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乙型肝炎病毒和透析患者

Author
Tak-Mao Chan, MD, FRCP
Section Editors
Steve J Schwab, MD
Martin S Hirsch, MD
Deputy Editor
Alice M Sheridan, MD
Translators
李荣宽, 主任医师，教授

引言

乙型肝炎病毒(hepatitis B virus, HBV)感染会导致急性或慢性肝炎、肝硬化或肝细胞癌。尽管自1982年以来已经有可用的有效疫苗，但是HBV感染在许多地区仍然呈地方性流行，全世界有超过3.5亿慢性HBV携带者。 (参见“乙型肝炎病毒感染的临床表现与自然病程”和“乙型肝炎病毒感染的流行病学、传播和预防”)

鉴于肾衰竭的免疫抑制作用、对新生性感染(de novo infection)和院内传播的易感性、对并发症发病率和死亡率的长期影响以及肾移植后临床病程的变化，透析患者中的HBV感染为一个独特的临床问题。透析患者HBV感染的自然病程也可能随感染的时机、基因型的不同而不同，因此也随地区的不同而不同。

在地方性流行地区，大部分HBV感染的成人透析患者为在儿童期早期获得HBV感染的慢性携带者。相比之下，非地方性流行地区的HBV感染通常于成年期获得。透析患者因为处于免疫抑制状态，所以与无肾衰竭的患者相比更容易成为HBV感染慢性携带者[1]。

大多数新近感染HBV的透析患者临床病程相对轻度[2]。感染患者通常无症状，并且血清氨基转移酶水平正常或仅轻微升高。来自腹膜透析患者的资料显示HBV感染本身对透析患者生存情况的影响相对较小[3]。

相比之下，感染HBV的肾移植受者存在重大的临床恶化风险。当移植后短时间内出现新生性HBV感染时，发生严重威及生命的并发症的风险最高，但是在乙型肝炎表面抗原(hepatitis B surface antigen, HBsAg)阳性的肾移植受者(包括透析过程中无症状的HBV携带者)中，肝炎发作以及肝脏相关并发症可在肾移植术后任何时间出现[4-7]。因此，尽管在透析患者中HBV感染为相对良性的临床疾病，但是必须强调透析患者预防和治疗HBV感染的重要性。

               

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Literature review current through: 2017-06 . | This topic last updated: 2015-08-14.
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