拉米夫定对异基因造血干细胞移植患者乙型肝炎病毒再激活的预防作用  

Lamivudine for the prevention of hepatitis B virus reactivation in patients undergoing allogeneic hematopoietic stem cell transplantation

作　　者：杨永公[1] 欧阳建[1] 孙雪梅[1] 许景艳[1] 陈兵[1] 张启国[1] 周敏[1] 

机构地区：[1]南京市鼓楼医院血液科,江苏南京210008

出　　处：《中国实用内科杂志》2007年第20期1624-1626,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨拉米夫定对异基因造血干细胞移植患者乙型肝炎病毒再激活的预防作用。方法2003年1月至2004年1月南京市鼓楼医院血液科3例行异基因造血干细胞移植的白血病患者中，2例乙型肝炎病毒表面抗原（HBsAg）阳性，HBV DNA分别为4.75×10^6。拷贝·mL^-1和1.15×10^6拷贝·mL^-1。另1例HBsAg阴性，但其供者HBsAg阳性，HBVDNA为3.48×10^7拷贝·mL^-1。对2例HBsAg阳性受者，移植前用拉米夫定；对HbsAg阴性受者干细胞回输时开始用拉米夫定，剂量均为0.1g每日1次，用至移植后1年。结果其中1例HBsAg阳性患者在移植后1个月内HBV DNA较高，波动于（1～1.2）X10^5拷贝·mL^-1，1个月后HBV DNA降低，〈3×10^4拷贝·mL^-1。移植后1周丙氨酸转氨酶（ALT）升高，最高达152U／L，持续1周后恢复正常。另1例移植后HBV DNA较低，持续〈1X10^5拷贝·mL^-1。无明显肝功能损害，ALT最高达56U／L。接受供者HB-sAg阳性患者移植后HBeAb阳性，HBcAb阳性，HBV DNA〈1X10^3拷贝·mL^-1。移植后10d ALT升高，最高达205U／L，持续1周后恢复正常。3例患者长期服用拉米夫定耐受性好，无明显毒副反应。结论初步观察表明，拉米夫定可以预防异基因造血干细胞移植患者乙型肝炎病毒再激活，无明显毒副反应。Objective To determine if lamivudine prophylaxis can prevent the reactivation of HBV in patients undergoing allogeneic hematopoietic stem cell transplantation. Methods Three leukemia patients who underwent allogeneic hem-atopoietic stem cell transplantation between Jan. 2003 and Jan. 2004 in our department were enrolled. Two patients were positive for HBsAg and the numbers of HBV-DNA copies were 4.75×10^6/mL and 1.15 × 10^6/mL respectively. The other patient was negative for HbsAg,but had a donor who was positive for HBsAg and the copy of HBV-DNA was 3.48 × 10^7/ mL Lamivudine was prospectively administered at a dose of 100 mg/day prior to HSCT for HBsAg positive recipients. And HBsAg negative recipients started Lamivudine treatment on the day of marrow infusion. The therapy lasted for 1 year after HSCT in all recipients. Results The number of HBV-DNA copies and liver function：the number of HBV-DNA copies fluctuated between 1 and 1.2 ×10^5/mL in one case among the first month after transplantion. It started to lower after one month and was controlled under 3 × 10^4/mL. The ALT value elevated one week after transplantion and got to 152 U/L. And it lasted for one week and then dropped within normal value. The number of HBV-DNA copies in another case was under 105/mL and no obvious abnormal liver function was observed. The highest value of ALT was 56 U/L. In still another ease the HBeAb and HBeAb were positive and the number of HBV DNA was less than 1 × 10^3/mL after transplant. The value of ALT elevated 10 days post-transplant with the top value of 205 U/L. And it lasted for one week and then got to normal range. Adverse effects of Lamivudine ： all three patients were well tolerant to long term administering of the drug and no major adverse effects were observed. Conclusion Preliminary observation suggests that prophylactic lamivudine could prevent hepatitis B virus reactivation in patients who has undergone allogeneic hematopoietic stem cell transplantation and no obvious adverse effect is observed.

关 键 词：拉米夫定 造血干细胞移植 异基因 乙型肝炎病毒再激活 

分 类 号：R5[医药卫生—内科学]