肝移植术后乙型肝炎病毒再感染的防治  

Prevention and treatment of hepatitis B virus reinfection after orthotopic Iiver transplantation

作　　者：张海斌[1] 李团结[1] 杨宁[1] 朱楠[1] 司马辉[1] 卢军华[1] 杨广顺[1] 

机构地区：[1]第二军医大学东方肝胆外科医院胆道二科,上海200438

出　　处：《中国普通外科杂志》2008年第7期633-635,共3页China Journal of General Surgery

摘　　要：目的 探讨肝移植术后乙型肝炎病毒（HBV）再感染的预防策略及效果。方法 对120例乙型肝炎、相关患者接受原位肝移植术后，使用肌内注射乙型肝炎免疫球蛋白（HBIg）联合拉米夫定或阿德福韦等治疗HBV再感染患者的临床资料进行回顾性总结。结果 经23～59个月随访，全组4例出现HBV再感染，再感染率为3．3％。4例经治疗后经随访19～26个月，均出现HBV-DNA转阴，但未见HBsAg转阴。结论 小剂量HBIg联合拉米夫定或阿德福韦可有效预防肝移植术后HBV的再感染；术前HBV-DNA负荷量与术后HBV再感染可能有关。Objective To investigate the strategy and outcome of prevention of hepatitis B virus （HBV） reinfection after orthotopic liver transplantation （OLT）. Methods A total of 120 patients with chronic fulminant hepatitis B, end-stage of liver cirrhosis and liver carcinoma were given hepatitis B immunoglobulin （HBIG） plus lamivudine or adefovir after OLT to prevent HBV reinfection. The serum HBV and HBV DNA were determined and clinical observation were performed. Results Follow-up time ranged from 23 - 59 （ median 45.2） months. Four patients had reinfection with positivity of HBsAg, HBeAb and HBcAb, the serum HBV DNA was also positive. All 4 patients became HBV-DNA negative after treatment and folloed-up for 19 -26 months, but HBsAg remained positive. Conclusions HBIG plus lamivudine or adefovir can effectively prevent HBV reinfection after OLT. Load level of HBV-DNA before OLT was related with HBV reinfection after operation.

关 键 词：肝移植 肝炎病毒 乙型 再感染 乙肝免疫球蛋白 

分 类 号：R617[医药卫生—外科学]