말기신부전 환자에서 투석 방법에 따른 C형 간염의 진행에 관한 연구

Abstract

Hepatitis C virus(HCV) infection is highly preva- lent in patients with ESRD treated in dialysis units, but there hss been little reports about the prevalence of HCV infection by detecting HCV RNA using poly- merase chain reaction (PCR) in Korea. We studied the prevalence of hepatitis C viremia using PCR in 46 anti HCV(+) ESRD patients(33 patients treated by hemodialysis(HD) and 13 patients by continuous ambulatory peritoneal dialysis(CAPD) ), the relationship between hepatitis C viremia and abnormal liver function, and the relationship between hepatitis C viremia and other clinical features(duration of dialysis, tranfusion history, mode of dialysis, etc.). HCV RNA was positive in 12 of 20 anti HCV(+) HD patients(60.0%)and 6 of 12 anti HCV(+) CAPD patients(50.0%) (not significantly different between the mode of dialysis). Abnormal liver func- tion was frequently observed in HCV RNA(+) pa- tients than in HCV RNA( ) patients(55.6% vs. 21.4 '@Y@o, p<0.05). There was no difference in the duration of dialysis, age, hematocrit, transfusion history, anti HBc positivity, and serum alanine aminotransferase (ALT) level between HCV RNA(+) and HCV RNA( )patients. In anti HCV(+) HD patients, ab- normal liver function was also frequent in HCV RNA(+) patients than in HCV RNA( ) patients (66.7% vs. 12.5%, p<0.05), and ALT was signifi- cantly higher in the former than in the latter(42.5± 24.6 vs. 19.4±21.2 IU/L, p<0.05). But in anti HCV (+) CAPD patients, there was no difference in any parameters between HCV RNA(+) and HCV RNA ( ) patients. Peritoneal liver biopsy was performed in 23 anti HCV(+) patients, and it revealed chronic persistent hepatitis in 17 patients, chronic antive hep- atitis in 3, hemosiderosis in 2, and liver cirrhosis in l. In 9 of these 23 patients in whom HCV RNA was tested, 5 were positive and 4 were negative for HCV RNA, and all 9 patients were chronic persistent hep- atitis on liver biopsy. In conclusion, abnormal liver function was fre- quently observed in HCV RNA(+) HD patients, but there was no difference in HCV RNA positivity according to the mode of dialysis in anti HCV(+ ) ESRD patients. However, large numbers of patients with a long term follow up duration may be needed to find more beneficial mode of dialysis to maintain normal liver function in HCV RNA positive ESRD patients.