摘要
目的：研究肾移植术后严重肝损害患者的临床结果。方法：分析１９９４年元月至１９９７年８月我院５１９例肾移植患者中３０例肝功严重受损患者的临床资料，ＨＣＶ－ＲＮＡ检测采用Ｎｅｓｔ－ＰＣＲ法，ＨＢｓＡｇ的测定采用ＥＬＩＳＡ法。结果：肝功严重损害患者ＨＢＶ、ＨＣＶ的感染率达９３．３％，死于肝衰竭９例，病死率为３０％，死亡患者均有ＨＢＶ或ＨＣＶ感染，且总胆红素峰值大于２００μｍｏｌ／Ｌ，存活患者急性排斥反应发生率为５７．１％，明显高于无肝功受损患者，这些患者均有停用硫唑嘌呤、环孢素Ａ或减少环孢素Ａ史。结论：ＨＢＶ、ＨＣＶ感染是肾移植术后肝功严重损害的主要原因，也是影响长期存活的重要原因之一，免疫抑制剂量不足是导致排斥反应增加的主要原因。
BJECTIVE To investigate the clinical causes and outcomes of renal transplant recipients with severe liver dysfunction.METHODOLOGY This study included 519 patients who received renal allografts between Janunary 1994 to August 1997.Patients with serum total bilirubin level greater than 49 μmol/L were classified as those with severe liver dysfunction after the exclusion of any obstructive cause.Serum HCVRNA was detected by RTNested PCR and serum HBsAg was detected by ELISA for the evaluation of the related causes of liver dysfunction.RESULTS Severe liver dysfunction was found in 58% of the renal graft recipients. HCVRNA was detected positive in 538% and HBsAg was detected in 567% of the patients with severe liver dysfunction .Hepatotoxicity caused by azathioprine and cyclosporin was found in one patient whose total serum bilirubin level returned to normal after the withdrawal of azathioprine and the decrease of cyclosporine.Nine patients with total serum bilirubin level more than 200 μmol died of hepatic failure .It was found that the occurrence of sever hepatic dysfunction was associated with the increased incidence of acute rejection.CONCLUSION Severe liver dysfunction directly affects the outcome of renal transplant recipients.HBV and HCV infection are the major causes of liver dysfunction in the recipients of renal transplant.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
1998年第1期31-33,共3页
Chinese Journal of Nephrology,Dialysis & Transplantation
