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  • 學位論文

抗病毒藥物治療對B型肝炎感染腎移植患者長期存活的影響

Impact of antiviral treatment on long-term survival of kidney transplant recipients with hepatitis B virus infection

指導教授 : 徐尚為
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摘要


背景及目的:移植病人的長期存活,始終是移植界所關注的主要問題。B型肝炎患者在腎臟移植後因接受大量免疫抑制劑的使用,可能會使術前所攜帶的肝炎病毒得以複製,輕者導致患者肝功能異常,重者併發肝衰竭導致死亡。對於B型肝炎病毒感染的腎臟移植患者是否於手術後,就需接受口服抗病毒藥物治療,時至今日仍無定論。故希望透過本研究,探討並分析B型肝炎病毒感染的腎臟移植患者其術後口服抗病毒藥物治療對於病患長期存活的影響。 方法:回溯性分析自2001年1月1日至2010年3月31日,於中山醫學大學附設醫院腎臟科追蹤共110位有B型肝炎感染之腎臟移植患者,將患者分成二組,一組於術後追蹤期間因B型肝炎復發造成肝功能異常而開始口服抗病毒藥物治療,另一組則因沒有發生肝炎復發而無接受抗病毒藥物治療,以卡方檢定探討各變數之關聯性,並以Kaplan -Meier存活函數及Cox比例危險複迴歸,探討二組病患之存活情形與影響病患存活之病患特性因子。 B型肝炎復發接受口服抗病毒藥物治療診斷標準:接受非肝臟之器官移植後患B肝發作者(指丙氨酸氨基轉移酶(ALT)超過正常值的上限),經消化系專科醫師同意後可長期使用。 結果:B型肝炎病毒感染之腎移植患者共有110位,於術後追蹤期間有42 (38.2%) 人因B型肝炎復發造成肝功能異常而接受口服抗病毒藥物治療,而沒有復發接受治療者共68 (61.8%) 人。由存活函數發現二組之存活情形沒有顯著差異 ( log rank test, P= 0.487)。從數據中發現,只有高血壓及術前透析病因對於病患存活結果有顯著影響,而其他病患特性因子,如性別、年齡、人類白血球抗原錯配個數、術前透析時間及方式、是否有糖尿病、高血脂及術後是否有急性排斥發作情形皆不會影響病患的存活情形。 結論:B 型肝炎病毒感染的腎臟移植患者,當發現患者產生病毒活躍而造成肝功能異常時,再開始給予口服抗病毒藥物使用,也能取得良好的治療效果,其病患存活情形與未復發之患者比較,二者並沒有顯著差異。不過,明確的證據還需要更大型的研究來證實。

關鍵字

腎移植 B型肝炎 存活分析

並列摘要


Background: Long-term survival of kidney transplant recipients (KTRs) remains an important issue. Reactivation of HBV may occur in the KTRs with HBV infection after kidney transplantation because of immunosuppressive therapy. The presentations of HBV reactivation may involve hepatitis, hepatic failure or death. However, it is controversial whether a KTR with HBV seropositivity should receive immediate prophylactic therapy after kidney transplantation. This study aimed to investigate the impact of preemptive HBV treatment on the survival of the KTRs with HBV infection. Methods: Between January 2001 and March 2010, 110 HBsAg seropositive KTRs in a single center in central Taiwan were enrolled in this retrospective study. The patients were subdivided into two groups including one with HBV flare-up and receiving oral antiviral therapy, the other one was with neither HBV flare-up nor treatment. HBV flare-up was defined as an increase in serum alanine aminotransferase (ALT) level more than upper limit of normal range. All data were analyzed with the SPSS14.0 package software. Results: Of the 110 patients, elevated serum ALT levels developed in 42 patients (38.2 percent) who were considered to be with HBV reactivation and oral antiviral treatment was given while 68 patients (61.8 percent) were without HBV flare-up. The risks for mortality included hypertension (p=0.048) and the primary cause of dialysis (p=0.038). The patient survival was not associated with age, gender, HLA mismatches, duration or modality of dialysis prior to kidney transplantation, diabetes mellitus, hyperlipidemia or acute rejection. The patient survival was comparable between the two groups (Log rank test, p= 0.487). Conclusion: The KTRs with HBV reactivation receiving preemptive HBV therapy were with comparable patient survival with those without HBV flare-up.

參考文獻


顏銘佐、林石化 (2009).透析患者之B型肝炎病毒感染.腎臟與透析,21(1),17-24。
王守玠、吳明儒(2004).腎臟移植病患之惡性腫瘤概論.腎臟與透析,16(2),81-90。
黃文宏、顏宗海、黃秋錦 (2003).B型肝炎和腎移植的關係.腎臟與透析,15(3),104-108。
Abecassis, M., Bartlett, S. T., Collins, A. J., Davis, C. L., Delmonico, F. L., Friedewald, J. J., et at. (2008). Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin JAm Soc Nephrol, 3(2), 71-480.
Anstey AV, Wakelin S, Reynolds NJ. (2004). British Association of Dermatologists Therapy, Guidelines and Audlt Subcommittee. Guidelines for prescribing azathioprine in dermatology. The British Journal of Dermatology. 151, 1123-1132.

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