乙型肝炎相关肝移植受体供肝植入前后乙型肝炎病毒标志物的变化  

Iuvestigation on the alteration of hepatitis B virus (HBV) markers in liver allograft of HBV related recipients in perioperative period

作　　者：戴军[1] 卢实春[1] 严律南[1] 李波[1] 赖威[1] 刘隽[1] 赵冀[1] 文天夫[1] 赵纪春[1] 顾梅[2] 林琦远[1] 王文雅[3] 张秀辉[4] 

机构地区：[1]四川大学华西医院普外科,成都610041 [2]首都医科大学附属同仁医院普外科肝脏移植中心 [3]四川大学华西医院感染性疾病中心 [4]四川大学华西医院病理科

出　　处：《中华肝脏病杂志》2004年第6期331-334,共4页Chinese Journal of Hepatology

摘　　要：目的 了解乙型肝炎相关受体在拉米夫定或拉米夫定+乙型肝炎免疫球蛋白(HBIG)预防下供肝植入前后移植物乙型肝炎病毒(HBV)标志物的变化,探讨移植物HBV再感染的可能机制,为预防复发寻找切入点。方法 用酶联放射免疫法、HBV DNA荧光定量法、免疫组织化学LSAB法定期检测78例受体手术前后血清及90例供肝活检组织,重点观察供肝植入前后HBV标志物在肝组织及血清中的动态变化。结果 移植时无论受体为HBV活跃复制状态或非活跃复制状态,供肝植入后2 h内活检肝组织既无HBV DNA又无HBsAg、HBcAg阳性证据。结论 在现有预防措施下,无论受体术前HBV复制状态如何,健康供肝无术中HBV颗粒直接感染的证据,其机制及在远期HBV再感染中的意义尚待进一步研究。Objective To investigate the alteration of HBV markers in liver allograft of HBV related recipients pre and post liver transplantation under Lamivudine or combination of Lamivudine with HBIG prophylaxis and explore the mechanism of HBV de nova infection in liver allograft after orthotopic liver transplantation, as well as seek to establish a optimal prophylactic protocol. Methods The serial liver biopsy specimens of 90 liver allograft and sera of 78 liver transplant recipients during operation and after 1 week, 1 month, 3 months, 6 months, 12 months, 24 months post transplantation have been collected and detected for HBV markers with Enzyme-linked radioimmunoassay, fluorescent quantitative assay for HBV-DNA in serology and with immunohistochemistry stain, HBV-DNA in situ hybridization in histology for detection of HBV markers in liver allograft samples. Results Whether recipients with active replicative or inactive replicative HBV preoperatively, none of positive HBV-DNA, HBsAg and HBcAg in 100% liver biopsy specimens with HBV-DNA hybridization in situ and immunohistochemistry stains in histology within 2 hours after reperfusion. Conclusion Whatever HBV replicative status the recipients have before surgery, no evidence of HBV particles direct invasion to the liver allograft from HBV related cirrhotics during operation under current prophylactic measures. However, the further supposed mechanism and its significance in HBV de nova infection of liver allograft remained to be disclosed further.

关 键 词：乙型肝炎 肝移植 受体 供肝植入 拉米夫定 乙型肝炎病毒 病毒标志物 

分 类 号：R657.3[医药卫生—外科学] R512.62[医药卫生—临床医学]