肝移植患者采取不同的方法应用乙型肝炎免疫球蛋白的随机和对照研究  

Randomized,controlled clinical trial on the medicating ways of hepatitis B immunoglobalin in patients undergoing liver transplantation

作　　者：牛玉坚 臧运金 陈新国 韦中余 张忠涛[2] 王宇[2] 沈中阳 

机构地区：[1]武装警察部队总医院器官移植研究所,北京100039 [2]首都医科大学附属北京友谊医院普外科

出　　处：《中华器官移植杂志》2007年第6期359-361,共3页Chinese Journal of Organ Transplantation

基　　金：中国博士后科学基金(2004035367)

摘　　要：目的研究肝移植患者术中和术后早期经不同方法应用乙型肝炎免疫球蛋白(HBIG)对血清乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)和乙型肝炎病毒(HBV)-DNA阴转速度的影响。方法将入选的乙型肝炎相关性肝病肝移植患者随机分为3组,每组30例。静脉注射组(静注组):通过静脉注射给予HBIG;肌肉注射组(肌注组):通过肌肉注射给予HBIG;序贯给药组(序贯组):即先静脉注射后肌肉注射给予HBIG。每组均在联合使用拉米夫定的情况下,于术中和术后6 d内给予相同剂量的HBIG。术后7 d内动态观察HBsAg、HBeAg和HBV-DNA的血清学转化情况。结果静注组和序贯组血清HBV-DNA在术后第2天全部转阴,肌注组第4天全部转阴。静注组和序贯组HBeAg于第3天全部转阴,肌注组于第4天全部转阴。静注组和序贯组HBsAg于第4天全部转阴,而肌注组经在第4天和第5天追加HBIG用量后,于第6天才全部转阴;静注组和序贯组术后5 d内每个时间点HBsAg的阴转率都显著高于肌注组(P<0.05)。结论静脉给药和序贯给药的血清HBV-DNA、HBeAg及HBsAg的阴转速度都显著快于肌肉注射给药,而序贯给药不仅能获得静脉给药的等同效果,且简单、易行,是一种更为合理的给药方法。Objective To investigate the effect of medicating ways for hepatitis B immunoglobulin （HBIG） on the serum conversion of HBsAg, HBeAg and HBV-DNA in patients undergoing liver transplantation. Methods The patients enrolled were randomized into three groups： i. v group, n = 30, HBIG injected intravenously; i. m group, n = 30, HBIG injected intramuscularly; sequential group （i. v first, followed by i. m）, n = 30. Under the combined utilization with lamivudine, HBIG were medicated in a same dosage among the three groups during anhepatic phase and the postoperative 6 days. The serum conversion of HBsAg, HBeAg and HBV-DNA was observed daily during the postoperative 7 days. Results 100 % of serum HBV-DNA negative-conversion was obtained in the i. v group and the sequential group on the postoperative day 2, but serum HBV-DNA negative-conversion was not obtained in the i. m group until postoperative day 4. 100 % of serum HBeAg negative-conversion was obtained in the i. v group and the sequential group on postoperative day 3, but serum HBeAg negative-conversion was not obtained in the i. m group until postoperative day 4. There was no difference in all the above changes between the i. v group and the sequential group. 100 % of serum HBsAg negative-conversion was obtained in the i. v group and the sequential group on postoperative day 4, but serum HBsAg negative-conversion was not obtained in the i. m group until postoperative day 6 by adding extra HBIG intravenously on postoperative day 4 and 5 respectively. The daily average negative-conversion rate of serum HBsAg was significantly faster in the i. v group and the sequential group than that in the i. m group within the postoperative 4 days （P〈0. 05）. Conclusions The negative-conversion of serum HBV-DNA, HBeAg and HBsAg was earlier in patients with HBIG medicated intravenously than that of intramuscularly. The similar results could be obtained in the sequential group like that in the i. v group. The sequential way is easier to be conducted than the i. v way,

关 键 词：肝移植 肝炎 乙型 慢性 免疫球蛋白类 

分 类 号：R657.3[医药卫生—外科学] R512.6[医药卫生—临床医学]