摘要
目的探讨乙肝相关性终末期肝病肝移植术后乙肝病毒再感染的防治。方法回顾性分析我院1999年10月到2007年10月肝移植109例乙肝相关性终末期肝病患者,移植后给予抗病毒预防乙型肝炎病毒再感染,拉米夫定治疗组50例、拉米夫定和乙肝免疫球蛋白(乙肝免疫球蛋白)联合治疗组59例,观察临床表现,血清HbsAg、血清HbeAg、血清HBV DNA及必要时肝穿刺免疫组织化学检测HbsAg等指标。结果109例接受了3个月～8年的抗病毒治疗随访。①拉米夫定治疗组50例,10例复发,复发率为20%,复发病例中2例分别于术后5个月、8个月死于乙肝复发爆发性肝炎;余8例给予阿德夫韦和乙肝免疫球蛋白后,肝功能好转,目前在随访中。②拉米夫定和乙肝免疫球蛋白联合治疗59例,2例复发,给予调整免疫抑制药后,肝功能好转。两组比较差异有统计学意义(χ2=7.622,P<0.05)。结论用拉米夫定和乙肝免疫球蛋白联合应用可以有效预防肝移植后乙型肝炎病毒的再感染。
Objective To discuss the prevention and treatment of hepatitis B virus re - infection after liver transplantation. Methods 109 cases with hepatitis B - related end - stage liver disease of transplantation patients were analyzed retrospectively of liver transplantations were analyzed retrospectively from October 1999 to October 2007. All patients were administered with antiviral drugs after transplantation to prevent hepatitis B virus re -infection, including 50 cases receiving Lamivudine, and 59 cases receiving Lamivudine and HBIg. The serum HBsAg, HBeAg and HBV DNA were determined, and liver biopsy immunohistochemistry was done when necessary. Results 109 patients were followed up for 3 months-8 years. （1） 10 of 50 （20%） cases receiving lamivudine developed re -infection, 2 cases （4%） of HBV re - infection were died of severe hepatitis B after 5 and 8 months, respectively. The remaining 8 cases were treated by adefovir and HBIg, and their liver function recovered quickly. （2） Two of 59 （ 3.39% ） cases receiving Lamivudine ＋ HBIg developed re - infection. The liver function was improved after adjusting the immunosuppressive drugs. There was significant difference between Lamivudine group and Lamivudine ＋ HBIg group （χ^2 = 7. 622,P 〈 0.05 ）. Conclusion Lamivudine and HBIg could effectively prevent hepatitis B virus re - infection after liver transplantation.
出处
《临床外科杂志》
2008年第11期749-751,共3页
Journal of Clinical Surgery
基金
南京军区十一五计划重点课题(06Z46)
关键词
肝移植
乙型肝炎病毒
再感染
防治
liver transplantation
hepatitis B virus
reinfection
prevention and cure
