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肾损伤成人患者中慢性丙型肝炎感染的治疗

Authors
Michael D Leise, MD
Lionel Rostaing, MD, PhD
Section Editors
Adrian M Di Bisceglie, MD
Fernando C Fervenza, MD, PhD
Deputy Editor
Allyson Bloom, MD
Translators
李莉, 主治医师

引言

慢性丙型肝炎病毒(hepatitis C virus, HCV)感染与一些肾小球疾病存在强烈并且可能为因果关系的联系，这些肾小球疾病包括混合型冷球蛋白血症、膜增生性肾小球肾炎(membranoproliferative glomerulonephritis, MPGN)以及可能的膜性肾病[1]。此外，与健康人群相比，在接受血液透析的患者中，抗HCV抗体的流行率更高，这提示透析患者获得HCV感染的风险可能更高。实际上，在美国的血液透析人群中，HCV抗体检测结果阳性率为5%-10%[2]。在这些患者中，抗病毒治疗可能较复杂，因为在肾功能损伤的情况下，多种抗HCV治疗药物会累积达到毒性水平。因此，有慢性HCV感染的肾病患者是需要特殊考虑的一类重要人群。

由于有新的直接作用抗病毒药(direct-acting antiviral, DAA)可用，预期在不久的将来，严重肾病成人患者[即，估计肾小球滤过率(estimated glomerular filtration rate, eGFR)<30mL/(min·1.73m2)]中HCV感染的治疗会有重大的改变。新的HCV药物已实现了对无肾功能损伤患者使用不含干扰素的方案以及(部分病例中)不含利巴韦林的方案。然而，将这些药物广泛用于历来难以治疗的肾病患者人群之前，必须在这类患者群体中进行研究。

本专题将讨论有肾损伤的HCV感染患者中抗病毒治疗的方法。然而，对于此类患者，其他治疗问题也可能很重要，如免疫抑制治疗，以及蛋白尿和高血压或肾病其他并发症的治疗。关于HCV感染相关的肾病、透析患者中HCV感染的流行病学与预防，以及肾移植相关的HCV感染的详细讨论参见其他专题：

●(参见“丙型肝炎病毒感染相关肾脏疾病概述”)

●(参见“Clinical manifestations and diagnosis of the mixed cryoglobulinemia syndrome (essential mixed cryoglobulinemia)”和“Treatment of the mixed cryoglobulinemia syndrome”)

                          

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-22.
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