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肾移植受者中的乙型肝炎病毒感染

Authors
Tak-Mao Chan, MD, FRCP
Anna SF Lok, MD
Section Editors
Daniel C Brennan, MD, FACP
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editors
Alice M Sheridan, MD
Jennifer Mitty, MD, MPH
Translators
党双锁, 主任医师，教授

引言

乙型肝炎病毒(hepatitis B virus, HBV)感染是肾移植后肝功能障碍的一个主要危险因素[1]，这是因为移植后需要进行免疫抑制治疗[2]。尽管透析患者中HBV感染的发病率有所下降，但患病率在流行地区仍然很高。

本专题将总结进行肾移植的终末期肾病(end-stage renal disease, ESRD)患者中HBV感染的预后和处理。HBV感染的血清学诊断和治疗的总体概述见其他专题。 (参见“乙型肝炎病毒感染的诊断”和“乙型肝炎治疗概述和病例分析”)

流行病学和危险因素

发病率和患病率 — 在流行地区，相当多接受肾移植的患者其乙型肝炎表面抗原(hepatitis B surface antigen, HBsAg)呈阳性。在这类地区，肾移植受者中所报道的HBV感染患病率约为15%[3]。在HBV较少见的地区，患病率则低得多。

总体来说，患病率在大多数国家似乎在下降，因为在一般人群和透析患者人群中实施了HBV疫苗接种计划以及采取了严格的预防措施来防止HBV感染在透析室传播。例如，2002年美国的一项全国监测数据显示，仅有1.0%的透析患者为HBsAg血清学阳性[4]。 (参见“乙型肝炎病毒和透析患者”)

HBV复制再激活的危险因素 — 在HBsAg阳性的患者中，HBV复制的再激活定义为先前检测不到HBV DNA的患者出现HBV DNA，或者HBV DNA增加大于(1-2)log。在HBsAg阴性、乙型肝炎病毒核心抗体(hepatitis B core antibody, anti-HBc)阳性的患者中，再激活定义为HBsAg或HBV DNA再现，或者是在开始免疫抑制治疗前可检测到HBV DNA的患者中HBV DNA增加。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-02.
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