循证治疗肾移植术后丙型病毒性肝炎1例报告_《中国循证医学杂志》

作者：

敖飞健 ,  何清 , 蒋金艳 , 唐蔚 , 张斌 , 李知玉 , 唐怡敏

深圳市第三人民医院肝病科（深圳 518020）;

关键词：

肾移植丙型肝炎干扰素利巴韦林循证治疗

DOI：

10.7507/1672-2531.20090222

视频：

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目的　总结1 例肾移植术后丙型病毒性肝炎患者的循证治疗方案。
方法　在充分评估患者病情的基础上，根据PICO 原则，提出临床问题并转换成便于检索的形式，检索Cochrane 图书馆（2009 年第1 期）、PubMed（1995 ～ 2009.3）和中国期刊全文数据库（CHKD，1995 ～ 2008.12）。
结果　共检索出治疗肾移植术后丙型肝炎抗病毒治疗的英文文献17 篇，其中Meta 分析1 篇；中文文献1 篇。目前肾移植术后丙型肝炎抗病毒治疗的措施有单用利巴韦林，单用干扰素及干扰素联合利巴韦林，以干扰素联合利巴韦林的效果最好。根据检索结果，结合患者意愿，笔者为患者制定了聚乙二醇干扰素α-2b 50 μg / 周联合利巴韦林600 mg/ 天治疗6 个月的方案。从治疗两个月后始，患者HCV RNA阴转，肝肾功能持续正常，未出现不良反应，患者对治疗效果满意。现已治疗6 个月，仍在随访观察中。
结论　聚乙二醇干扰素联合利巴韦林可用于肾移植术后丙型肝炎的抗病毒治疗，并能维持移植肾的功能。

引用本文： 敖飞健,何清,蒋金艳,唐蔚,张斌,李知玉,唐怡敏. 循证治疗肾移植术后丙型病毒性肝炎1例报告. 中国循证医学杂志, 2009, 09(11): 1238-1240. doi: 10.7507/1672-2531.20090222 复制

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.	唐晓鹏, 赵洪雯, 余荣杰, 等. 小剂量干扰素α联合利巴韦林治疗肾移植术后继发丙型病毒性肝炎患者的疗效观察. 第三军医大学学报, 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. 唐晓鹏, 赵洪雯, 余荣杰, 等. 小剂量干扰素α联合利巴韦林治疗肾移植术后继发丙型病毒性肝炎患者的疗效观察. 第三军医大学学报, 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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《中国循证医学杂志》

循证治疗肾移植术后丙型病毒性肝炎1例报告

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