肾功能下降与乙型肝炎病毒感染、丙氨酸转氨酶水平升高之间的关联

Background and objectives Clinically, hepatitis B virus (HBV) infection is observed to be associated with nephropathy. However, previous population-based studies failed to show an association between HBV infection and CKD. Therefore, this cross-sectional study was designed to further explore this association. Design, setting, participants, & measurements A representative sample of 6854 Chinese adults aged 30-75 years was tested for levels of serum hepatitis B surface antigen, alanine aminotransferase (ALT), creatinine, urinary albumin/creatinine ratio, and potential CKD risk factors. Results Neither HBV infection nor elevated ALT (ALT+; ≥ sex-specific 90th percentile of ALT levels of noninfected persons) was significantly associated with reduced estimated GFR (eGFR< 60 ml/min per 1.73 m 2). Compared with non infected persons, HBV-infected persons with ALT+, but not those with ALT2(P=0.26),were more likely to have reduced eGFR (odds ratio, 4.07; 95% confidence interval, 1.18-14.0; P=0.03). Further analysis with a general linear model revealed a significant difference in eGFR (mean ± SEM) between HBV-infected and non infected persons (87.8±0.8 versus 90.2±0.4ml/min per 1.73m 2; P=0.002). This difference was mainly derived from that between HBV-infected persons with ALT+ and non infected persons, with an average difference in eGFR of24.5 (95% confidence interval,20.9 to 28.1; P=0.01). HBV infection and ALT+, alone or in combination, were not significantly associated with albuminuria or CKD. Conclusions HBV infection with elevated ALT, rather than HBV infection alone, was associated with reduced renal function. © 2012 by the American Society of Nephrology.

Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China