肝移植后乙型肝炎复发的临床表现与预后  

Clinical manefestations and prognosis of the patients with hepatitis B recurrence after orthotopic liver transplantation

作　　者：王笑梅[1] 兰孟东[2] 段英[1] 卜志军[1] 高岚[1] 马烈[1] 王凤水[1] 成军[1] 

机构地区：[1]北京地坛医院北京肝移植康复中心 [2]北京地坛医院病理科,北京100011

出　　处：《胃肠病学和肝病学杂志》2008年第1期55-58,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的 研究肝移植后乙型肝炎复发的临床特点、治疗和预后。方法 回顾性分析25例因终末期乙肝肝病行肝移植的患者术后乙型肝炎复发的临床类型、乙肝病毒指标的变化、对抗病毒再治疗的反应以及预后。结果肝移植后乙型肝炎复发的高峰时间是在第1年；YMDD变异在拉米夫定失效患者中占61％；本组病例肝移植后乙型肝炎复发呈现3种临床类型：①纤维淤胆型肝炎，占8％（2／25），病情凶险，病死率高。②亚急性重型肝炎，占12％（3／25），恢复期后表现为肝硬化。③慢性肝炎，占80％（20／25），其中包括活动型和轻型。病情呈活动型者占48％（12／25），其中病情进展较快者可在4～5年内进展为肝硬化。预后与肝病活动程度关系密切，需要与排异反应及药物中毒相鉴别。病情呈轻型占32％（8／25），表现为一过性肝功能异常，预后较好。25例乙型肝炎复发患者，死亡2例，死亡原因均为纤维淤胆型肝炎。结论 肝移植后乙型肝炎复发的临床表现类型与抗病毒治疗是否及时有效密切相关，应用核苷类似物联合乙肝免疫球蛋白治疗，能有效地预防及治疗肝移植术后乙型肝炎复发。早期发现乙型肝炎复发并及时调整治疗，能显著改善患者的预后。Objective To investigate the clinical features, treatment effect and prognosis of orthotopic liver transplantation （OLT） patients when hepatitis B recurrence occured. Methods Twenty-five adult OLT patients due to HBV- related end stage liver disease were studied by retrosective review. Results The most common period of hepatitis B recurrence was in the first year after OLT operation. YMDD mutation was of 61% in patients with relapse of lamivudine treatment. Clinical manifestations presented as 3 types：① Fibrosing cholestatic hepatitis： 2 of 25 （8%） cases were in serious condition with high mortality. Both of the two cases died. ② Severe hepatitis： 3 of 25 （12%） cases. They manifested liver cirrhosis. ③ Chronic hepatitis： 20 of 25 （80%） cases, including active type and mild type. Twelve of 25 （48%） cases were of active type. Some progressive cases could develop to liver cirrhosis within 4 -5 years. Prognosis was closely related to the activities of liver disease. The diagnosis should be differentiated from rejection and poisoning of medicine; 8 of 25 （32%） cases were of mild type, shown as transient liver function abnormal and recovered smoothly. This type usually occurred at early stage of hepatitis B recurrence and got effective anti-HBV virus treatment soon. Prognosis presented good in this type. Conclusion The types of clinical manifestation in OLT patients after HBV recurrence are closely related to the effective treatment of anti-hepatitis B virus. Administering nucleoside analogue combined with hepatitis B immunoglobin can treat HBV recurrence after OLT operation. Early discovery and change to effective anti- HBV medicine in time can improve greatly the prognosis of the patients.

关 键 词：肝移植 乙型肝炎病毒 复发 纤维淤胆型肝炎 

分 类 号：R512.6[医药卫生—内科学]