循證治療腎移植術后丙型病毒性肝炎1例報告_《中國循證醫學雜志》

作者：

敖飛健 ,  何清 , 蔣金艷 , 唐蔚 , 張斌 , 李知玉 , 唐怡敏

深圳市第三人民醫院肝病科（深圳 518020）;

關鍵詞：

腎移植丙型肝炎干擾素利巴韋林循證治療

DOI：

10.7507/1672-2531.20090222

視頻：

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目的　總結1 例腎移植術后丙型病毒性肝炎患者的循證治療方案。
方法　在充分評估患者病情的基礎上，根據PICO 原則，提出臨床問題并轉換成便于檢索的形式，檢索Cochrane 圖書館（2009 年第1 期）、PubMed（1995 ～ 2009.3）和中國期刊全文數據庫（CHKD，1995 ～ 2008.12）。
結果　共檢索出治療腎移植術后丙型肝炎抗病毒治療的英文文獻17 篇，其中Meta 分析1 篇；中文文獻1 篇。目前腎移植術后丙型肝炎抗病毒治療的措施有單用利巴韋林，單用干擾素及干擾素聯合利巴韋林，以干擾素聯合利巴韋林的效果最好。根據檢索結果，結合患者意愿，筆者為患者制定了聚乙二醇干擾素α-2b 50 μg / 周聯合利巴韋林600 mg/ 天治療6 個月的方案。從治療兩個月后始，患者HCV RNA陰轉，肝腎功能持續正常，未出現不良反應，患者對治療效果滿意。現已治療6 個月，仍在隨訪觀察中。
結論　聚乙二醇干擾素聯合利巴韋林可用于腎移植術后丙型肝炎的抗病毒治療，并能維持移植腎的功能。

引用本文： 敖飛健,何清,蔣金艷,唐蔚,張斌,李知玉,唐怡敏. 循證治療腎移植術后丙型病毒性肝炎1例報告. 中國循證醫學雜志, 2009, 09(11): 1238-1240. doi: 10.7507/1672-2531.20090222 復制

1.	Pageaux GP, Hilleret MN, Garrigues V, et al. Pegylated interferonalpha- based treatment for chronic hepatitis C in renal transplant recipients: an open pilot study. Transpl Int, 2009, 22(5): 562-567.
2.	Nanmoku K, Imaizumi R, Toj imbara T, e t al . Ef fect s of immunosuppressants on the progression of hepatitis C in hepatitis C virus-positive renal transplantation and the usefulness of interferon therapy. Transplant Proc, 2008, 40(7): 2382-2385.
3.	Rashid A, Abboud O, Al-Kaabi S, et al. The Impact of Hepatitis C Infection and Antiviral Therapy on clinical Outcome in Renal Transplantation Recipients. Saudi J Kidney Dis Transpl, 1999, 10(1): 31-35.
4.	Montalbano M, Pasulo L, Sonzogni A, et al. Treatment with pegylated interferon and ribavirin for hepatitis C virus-associated severe cryoglobulinemia in a liver/kidney transplant recipient. J Clin Gastroenterol, 2007, 41(2): 216-220.
5.	Sharma RK, Bansal SB, Gupta A, et al. Chronic hepatitis C virus infection in renal transplant: treatment and outcome. Clin Transplant, 2006, 20(6): 677-683.
6.	Carbognin SJ, Solomon NM, Yeo FE, et al. Acute renal allograft rejection following pegylated IFN-alpha treatment for chronic HCV in a repeat allograft recipient on hemodialysis: a case report. Am J Transplant, 2006, 6(7): 1746-1751.
7.	Zeman M, Campbel l P, Bain VG. Hepat i t is C eradicat ion and improvement of cryoglobulinemia-associated rash and membranoproliferative glomerulonephritis with interferon and ribavirin after kidney transplantation. Can J Gastroenterol, 2006, 20(6): 427-431.
8.	Konishi I, Horiike N, Michitaka K, et al. Renal transplant recipient with chronic hepatitis C who obtained sustained viral response after interferon-beta therapy. Intern Med, 2004, 43(10): 931-934.
9.	Shu KH, Lan JL, Wu MJ, et al. Ultralow-dose alpha-interferon plus ribavirin for the treatment of active hepatitis C in renal transplant recipients. Transplantation, 2004, 77(12): 1894-1896.
10.	Tang S, Cheng IK, Leung VK, et al. Successful treatment of hepatitis C after kidney transplantation with combined interferon alpha-2b and ribavirin. J Hepatol, 2003, 39(5): 875-878.
11.	Luciani G, Bossola M, Muscaritoli M, et al. Sustained response with negative serum HCV-mRNA and disappearance of antibodies after interferon-alpha therapy in a kidney transplant recipient with chronic active viral hepatitis C. J Nephrol, 2003, 16(3): 417-420.
12.	Baid S, Tolkoff-Rubin N, Saidman S, et al. Acute humoral rejection in hepatitis C-infected renal transplant recipients receiving antiviral therapy. Am J Transplant, 2003, 3(1): 74-78.
13.	Schmitz V, Kiessling A, Bahra M, et al. Peginterferon alfa-2b plus ribavirin for the treatment of hepatitis C recurrence following combined liver and kidney transplantation. Ann Transplant, 2007, 12(3): 22-27.
14.	Kamar N, Boulestin A, Selves J, et al. Factors accelerating liver fibrosis progression in renal transplant patients receiving ribavirin monotherapy for chronic hepatitis C. J Med Virol, 2005, 76(1): 61-68.
15.	Fontaine H, Vallet-Pichard A, Equi-Andrade C, et al. Histopathologic efficacy of ribavirin monotherapy in kidney allograft recipients with chronic hepatitis C. Transplantation, 2004, 78(6): 853-857.
16.	Kamar N, Sandres-Saune K, Selves J, et al. Long-term ribavirin therapy in hepatitis C virus-positive renal transplant patients: effects on renal function and liver histology. Am J Kidney Dis, 2003, 42(1): 184-192.
17.	Fabrizi F, Lunghi G, Dixit V, et al. Meta-analysis: anti-viral therapy of hepatitis C virus-related liver disease in renal transplant patients. Alimentary Pharmacology and Therapeutics, 2006, 24(10): 1413-1422.
18.	唐曉鵬, 趙洪雯, 余榮杰, 等. 小劑量干擾素α聯合利巴韋林治療腎移植術后繼發丙型病毒性肝炎患者的療效觀察. 第三軍醫大學學報, 2008, 30(2): 117-119.
19.	Pereira BJG, Natov SN, Bouthot BA, et al. Effect of hepatitis C infection and renal transplantation on survival in end-stage renal disease. Kidney Int, 1998, 53: 1374-1381.
20.	Mathurin P, Mouquet C, Poynard T, et al. Impact of hepatitis B and C virus on kidney transplantation outcome. Hepatology, 1999, 29: 257-263.

1. Pageaux GP, Hilleret MN, Garrigues V, et al. Pegylated interferonalpha- based treatment for chronic hepatitis C in renal transplant recipients: an open pilot study. Transpl Int, 2009, 22(5): 562-567.
2. Nanmoku K, Imaizumi R, Toj imbara T, e t al . Ef fect s of immunosuppressants on the progression of hepatitis C in hepatitis C virus-positive renal transplantation and the usefulness of interferon therapy. Transplant Proc, 2008, 40(7): 2382-2385.
3. Rashid A, Abboud O, Al-Kaabi S, et al. The Impact of Hepatitis C Infection and Antiviral Therapy on clinical Outcome in Renal Transplantation Recipients. Saudi J Kidney Dis Transpl, 1999, 10(1): 31-35.
4. Montalbano M, Pasulo L, Sonzogni A, et al. Treatment with pegylated interferon and ribavirin for hepatitis C virus-associated severe cryoglobulinemia in a liver/kidney transplant recipient. J Clin Gastroenterol, 2007, 41(2): 216-220.
5. Sharma RK, Bansal SB, Gupta A, et al. Chronic hepatitis C virus infection in renal transplant: treatment and outcome. Clin Transplant, 2006, 20(6): 677-683.
6. Carbognin SJ, Solomon NM, Yeo FE, et al. Acute renal allograft rejection following pegylated IFN-alpha treatment for chronic HCV in a repeat allograft recipient on hemodialysis: a case report. Am J Transplant, 2006, 6(7): 1746-1751.
7. Zeman M, Campbel l P, Bain VG. Hepat i t is C eradicat ion and improvement of cryoglobulinemia-associated rash and membranoproliferative glomerulonephritis with interferon and ribavirin after kidney transplantation. Can J Gastroenterol, 2006, 20(6): 427-431.
8. Konishi I, Horiike N, Michitaka K, et al. Renal transplant recipient with chronic hepatitis C who obtained sustained viral response after interferon-beta therapy. Intern Med, 2004, 43(10): 931-934.
9. Shu KH, Lan JL, Wu MJ, et al. Ultralow-dose alpha-interferon plus ribavirin for the treatment of active hepatitis C in renal transplant recipients. Transplantation, 2004, 77(12): 1894-1896.
10. Tang S, Cheng IK, Leung VK, et al. Successful treatment of hepatitis C after kidney transplantation with combined interferon alpha-2b and ribavirin. J Hepatol, 2003, 39(5): 875-878.
11. Luciani G, Bossola M, Muscaritoli M, et al. Sustained response with negative serum HCV-mRNA and disappearance of antibodies after interferon-alpha therapy in a kidney transplant recipient with chronic active viral hepatitis C. J Nephrol, 2003, 16(3): 417-420.
12. Baid S, Tolkoff-Rubin N, Saidman S, et al. Acute humoral rejection in hepatitis C-infected renal transplant recipients receiving antiviral therapy. Am J Transplant, 2003, 3(1): 74-78.
13. Schmitz V, Kiessling A, Bahra M, et al. Peginterferon alfa-2b plus ribavirin for the treatment of hepatitis C recurrence following combined liver and kidney transplantation. Ann Transplant, 2007, 12(3): 22-27.
14. Kamar N, Boulestin A, Selves J, et al. Factors accelerating liver fibrosis progression in renal transplant patients receiving ribavirin monotherapy for chronic hepatitis C. J Med Virol, 2005, 76(1): 61-68.
15. Fontaine H, Vallet-Pichard A, Equi-Andrade C, et al. Histopathologic efficacy of ribavirin monotherapy in kidney allograft recipients with chronic hepatitis C. Transplantation, 2004, 78(6): 853-857.
16. Kamar N, Sandres-Saune K, Selves J, et al. Long-term ribavirin therapy in hepatitis C virus-positive renal transplant patients: effects on renal function and liver histology. Am J Kidney Dis, 2003, 42(1): 184-192.
17. Fabrizi F, Lunghi G, Dixit V, et al. Meta-analysis: anti-viral therapy of hepatitis C virus-related liver disease in renal transplant patients. Alimentary Pharmacology and Therapeutics, 2006, 24(10): 1413-1422.
18. 唐曉鵬, 趙洪雯, 余榮杰, 等. 小劑量干擾素α聯合利巴韋林治療腎移植術后繼發丙型病毒性肝炎患者的療效觀察. 第三軍醫大學學報, 2008, 30(2): 117-119.
19. Pereira BJG, Natov SN, Bouthot BA, et al. Effect of hepatitis C infection and renal transplantation on survival in end-stage renal disease. Kidney Int, 1998, 53: 1374-1381.
20. Mathurin P, Mouquet C, Poynard T, et al. Impact of hepatitis B and C virus on kidney transplantation outcome. Hepatology, 1999, 29: 257-263.

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循證治療腎移植術后丙型病毒性肝炎1例報告

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