هپاتیت B در مبتلایان به بیماری مرحله‌ی پایانی کلیه، تحت درمان با همودیالیز

نوع مقاله : مقاله مروری

نویسندگان

1 دانشیار، مرکز تحقیقات نارسایی مزمن کلیه، دانشگاه علوم پزشکی جندی‌شاپور اهواز، اهواز، ایران

2 استاد، مرکز تحقیقات نارسایی مزمن کلیه، دانشگاه علوم پزشکی جندی‌شاپور اهواز، اهواز، ایران

3 دانشجوی پزشکی، مرکز تحقیقات نارسایی مزمن کلیه، دانشگاه علوم پزشکی جندی‌شاپور اهواز، اهواز، ایران

4 انستیتو پژوهشی نیکان، اصفهان، ایران

5 استاد، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

با وجود همه‌ی روش‌های پیش‌گیری، ویروس هپاتیت B (HBV یا Hepatitis B virus)، که می‌تواند عامل ایجاد هپاتیت حاد و مزمن، سیروز و سرطان کبد باشد، همچنان در بسیاری از مناطق به صورت اندمیک باقی مانده است و بیش از 350 میلیون نفر در جهان ناقل مزمن این ویروس هستند. بروز عفونت هپاتیت B در بیماران با نارسایی مزمن کلیه در طول چند دهه‌ی گذشته، به دنبال اقداماتی نظیر غربال‌گری خون از نظر Hepatitis B surface antigen (HBsAg) و Anti-Hepatitis B core total antibodies (Anti-HBc)، کاهش نیاز به انتقال خون پس از پیدایش اریتروپویتین واکسیناسیون هپاتیت B و انجام اقدامات کنترل عفونت در واحدهای همودیالیز به طور قابل توجهی کاهش یافته است. به نظر می‌رسد که در اکثر بیماران مبتلا به بیماری مرحله‌ی پایانی کلیه، آزمایش HBsAg برای تشخیص عفونت ویروس هپاتیت B کافی است. با این وجود، با توجه به این که علایم بیوشیمیایی اغلب نمی‌تواند به طور قابل اعتمادی وضعیت بافت‌شناسی کبد را نشان دهد، بیوپسی کبدی بهترین روش برای ارزیابی فعالیت هپاتیت B و درجه‌ی سیروز می‌باشد. بیوپسی کبد، اغلب هنگامی توصیه می‌شود که درمان آنتی‌ویروس و قبل از آن، انجام پیوند کلیه برای ارزیابی شدت بیماری کبدی ناشی از HBV مد نظر باشد. با توجه به عوارض جانبی اینترفرون آلفا در بیماران تحت دیالیز، آنالوگ‌های نوکلئوزیدی، انتخاب‌های بهتری در درمان هپاتیت B این بیماران می‌باشند. در پایان، باید اشاره شود که انتکاویر خوراکی، اولین خط درمان توصیه شده برای هپاتیت B در این بیماران می‌باشد.

کلیدواژه‌ها

عنوان مقاله [English]

Hepatitis B in Patients with End-Stage Renal Disease Undergoing Maintenance Hemodialysis

نویسندگان [English]

  • Seyed Seifollah Beladi-Mousavi 1
  • Heshmatollah Shahbazian 2
  • Mohammad Faramarzi 3
  • Samaneh khodadadi 4
  • Hamid Nasri 5
1 Associate Professor, Chronic Renal Failure Research Center, Jundishapour University of Medical Sciences, Ahwaz, Iran
2 Professor, Chronic Renal Failure Research Center, Jundishapour University of Medical Sciences, Ahwaz, Iran
3 Student of Medicine, Chronic Renal Failure Research Center, Jundishapour University of Medical Sciences, Ahvaz, Iran
4 Nickan Research Institute, Isfahan, Iran
5 Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Despite all prevention methods, hepatitis B virus (HBV), which can cause acute and chronic hepatitis, cirrhosis and liver cancer, still has remained endemic in many areas and more than 350 million people are chronic carriers of this virus in the world. The incidence of hepatitis B infection has significantly decreased among the patients with end stage renal disease during the past few decades due to factors such as blood screening for HBsAg and anti-HBc, reducing the need for blood transfusion after the advent of erythropoietin, hepatitis B vaccination and the implementation of infection control measures in hemodialysis units. It seems that HBsAg test is sufficient for the diagnosis of HBV infection in most end stage renal disease (ESRD) patients. However since the biochemical tests often cannot be reliable to indicate the status of liver pathology, the liver biopsy is the best method to ascertain the activity of hepatitis and the degree of cirrhosis. It is often recommended when antiviral treatment is being considered and before kidney transplantation for assesses the activity of HBV-related liver disease. According to the side effects of interferon-alfa among dialysis patients, nucleoside analogs are better choices for the treatment of hepatitis B among these patients. Finally it should be noted that Entecavir is the recommended first-line oral medication for hepatitis B among these patients.

کلیدواژه‌ها [English]

  • Hepatitis B
  • Chronic renal failure
  • Hemodialysis

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مجله دانشکده پزشکی اصفهان
دوره 34، شماره 380 - شماره پیاپی 380
خرداد و تیر 1395
صفحه 450-459

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  • تاریخ دریافت: 16 اردیبهشت 1394
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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