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目的 :了解慢性肾衰 (CRF)合并病毒性肝炎患者肾移植前进行肝活检的安全性及临床价值。 方法 :分析 1 996年元月至 1 998年 6月我院 2 4例CRF合并慢性病毒性肝炎患者肾移植前行经皮肝活检的安全性及组织病理结果。其中 1 4例接受肾移植并对其进行长期随访。 结果 :2 4例患者肝活检的成功率 1 0 0 %。并发症的发生率为 33 3% ,需输血治疗者 4例 (1 6 7% ) ;无一例需手术治疗或死亡。 2 4例患者中 ,明确诊断为慢性乙型肝炎者 1 1例、丙型肝炎 1 1例、2例乙肝合并丙肝。 1 8例患者 (75 0 % )病理表现为慢性迁延性肝炎 ;4例 (1 6 7% )为慢性活动性肝炎 ;2例 (8 3% )为小结节性肝硬化。 1 4例组织学诊断为慢性迁延性肝炎的患者分别在肝活检后 1～ 8个月接受了肾移植。其中乙肝 7例 ,丙肝 6例 ,乙肝伴丙肝 1例。术后有 1 0例接受CsA +MMF +Pred ,4例接受CsA+AZA +Pred三联免疫抑制治疗。肾移植后平均随访 35 9个月 ,1 4例患者中 3例死亡 (2例肝衰 ,均为乙肝 ;1例CMV感染 ) ;3例因慢性排斥重新接受血透。移植肾有功能的 8例患者中 ,6例肾功能持续正常 ,2例伴有慢性排斥。 结论 :CRF合并慢性肝炎患者肾移植前肝活检是有必要的 ,可以发现不宜行肾移植的慢性活动性肝炎、肝硬化等病变。慢性迁延性
Objective: To investigate the safety and clinical value of liver biopsy before kidney transplantation in patients with chronic renal failure (CRF) and viral hepatitis. Methods: From January 1996 to June 1998, the safety and histopathological results of percutaneous transhepatic biopsy of 24 CRF patients with chronic viral hepatitis before renal transplantation were analyzed. Of these, 14 received kidney transplantation and were followed up for a long time. Results: The success rate of liver biopsy in 240 patients was 100%. The incidence of complications was 33.3%. Four patients (16.7%) needed blood transfusions. None required any surgical treatment or death. Twenty-four patients were diagnosed as chronic hepatitis B in 11 cases, hepatitis C in 11 cases, and hepatitis B in 2 cases. Eighty-eight patients (75%) had chronic persistent hepatitis, 4 (167%) had chronic active hepatitis and 2 (83%) had nodular cirrhosis. Twenty-four patients with histologically diagnosed chronic persistent hepatitis received a kidney transplant 1 to 8 months after liver biopsy. Of which 7 cases of hepatitis B, hepatitis C in 6 cases, hepatitis B with hepatitis C in 1 case. Postoperatively, 10 received CsA + MMF + Pred and 4 received CsA + AZA + Pred triple immunosuppression. After a mean follow-up of 359 months after kidney transplantation, 3 of 14 patients died of hepatitis B (both hepatitis B and 1 CMV infection), and 3 of them received hemodialysis again due to chronic rejection. Of the 8 patients with functional graft function, 6 had normal renal function and 2 had chronic rejection. Conclusions: Liver biopsy of CRF patients with chronic hepatitis before renal transplantation is necessary. Chronic active hepatitis and liver cirrhosis not suitable for renal transplantation may be found. Chronic persistence