2018-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658843摘要：台灣這幾年不論是末期腎病的發生率或盛行率都高居全球第一，而台灣同時也是肝炎的盛行區。本院慢性腎臟病團隊與中央研究院肝炎團隊合作下，發現慢性C型肝炎感染與慢性腎臟病有高度相關，而B型肝炎與慢性腎臟病的關係則沒有定論，且之前的研究只有以B型肝炎表面抗原陽性來定義感染。本研究探討B型肝炎感染從病毒因子到伺主因子對於慢性腎臟病以至於末期腎病變的影響。資料來源是The Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer (REVEAL) ：一個以社區為主兩萬多人的世代研究。經長期追蹤至今已超過20年。初始與每年定期測定的病毒相關因子包括各種抗原、抗體、病毒量與基因型。第一部分我們將透過衛生福利資料科學中心以去連結匿名的方式串聯健保研究資料庫，獲得病人用藥、就醫紀錄與長期預後的診斷。首先分析初始的病毒標記在校正傳統慢性腎臟病因子後對於發展成末期腎病的影響；其次將透析前死亡當作競爭因子做分析，看B型肝炎病毒對於末期腎病發生的風險比值。第二部分我們執行一個病案對照研究，在配對年齡、性別、肝功能、B型肝炎病毒量與基因型後，看末期腎病個案與對照組間伺主免疫因子，包括初始的各種細胞激素，譬如干擾素、介白素與腫瘤壞死因子等，有無顯著差異。並且分析細胞激素彼此間與病毒因子間的交互反應，以期能從病毒端到飼主端看慢性B型感染對於慢性腎臟病的各種層面的影響。此研究希望能確認B型肝炎病毒感染對於慢性腎臟病的影響，找出決定的病毒因子與伺主因子，以提供適當的證據預防與治療。對於慢性腎臟病的防治與B型肝炎的治療效做出重要的貢獻。<br> Abstract: Taiwan shares the highest prevalence and incidence of end-stage renal disease worldwide. Taiwan are also an endemic area of hepatitis B/C infection. Our previous researches demonstrated that chronic hepatitis C virus infection was a strong predictor of chronic kidney disease (CKD) and developing end-stage renal disease (ESRD), but the association between hepatitis B (HBV) infection and chronic kidney disease remain uncertain. Besides, previous study defined HBV infection by use of HBV surface antigen only, and other viral markers are lacking. The first part of our research is a prospective cohort study. The data source is the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer (REVEAL), a large-scale community-based cohort longitudinal follow-up for more than 15 years. Outcome and covariates are ascertained by linkage of REVEAL to National Health Insurance Research Database and death certification system. We investigated HBV viral markers, such as surface antigen titer, HBV DNA levels and HBV genotype and their risk of developing end-stage renal disease. We will also perform a competing risk analysis taking pre-ESRD death as a competing events of ESRD to confirm the true association between HBV infection and ESRD development. In the second part of our project, we will conduct a case-control study to examine the role of host factors, including various cytokines such as interferons, interleukin family and tumor necrotizing factors, to see their interaction with viral factors and impact of chronic kidney disease. We hope to demonstrate the association between chronic hepatitis B infection and chronic kidney disease; find out the determinants of viral markers of developing ESRD and assure the role of host immunological factors on the impact of renal outcomes. Our study will provide strong evidence that HBV eradication may help reduce parts of CKD and will have a great contribution of CKD prevention policy.B型肝炎基因型慢性腎臟病末期腎病變透析細胞激素競爭死因流行病學hepatitis Bchronic kidney diseaseend-stage renal diseasecytokinescompeting riskepidemiology