肝移植术后乙型肝炎复发的预防  

Prophylaxsis against recurrance of hepatitis B virus after liver transplantation

作　　者：武聚山[1] 卢实春[1] 王梦龙[1] 夏仁品[1] 郭庆良[1] 高大明[1] 张毅[1] 刘源[1] 李宁[1] 

机构地区：[1]首都医科大学附属北京佑安医院普外中心,北京100069

出　　处：《中华实验和临床病毒学杂志》2008年第5期367-369,共3页Chinese Journal of Experimental and Clinical Virology

基　　金：首都医科大学基础与临床合作基金资助（2006JL55）

摘　　要：目的总结肝移植术后预防乙型肝炎复发的临床经验，探讨预防乙肝病毒再感染的个体化治疗措施。方法回顾性分析我院2004年7月至2008年6月完成的195例乙肝相关性终末期肝病患者的肝移植临床资料，按照其移植术后抗病毒方案不同分为两组：A组（168例）应用拉米夫定（LAM）联合乙肝免疫球蛋白（HBIG）；B组（27例）应用阿德福韦（ADF）联合乙肝免疫球蛋白。平均随访（23．7±13．4）月，观察总体及两组复发率。结果A组和B组各复发1例，复发时间分别在术后6个月至11个月，复发率分别为0．6％（1／168）和3．7％（1／27），总体复发率为1％。两组复发率差异无统计学意义（P=0．14）。结论拉米夫定联合HBIG可有效预防肝移植术后乙型肝炎复发，根据术前病毒携带情况调整抗病毒方案与HBIG用量可获得满意疗效。Objective To summarize the clinical data in preventing HBV recurrence after liver transplantation and explore a optimal individual protocol in prophylaxis of HBV recurrence. Methods We retrospected outcomes in 195 recipients who underwent a liver transplantation for HBV-related liver disease between June 2004 and July 2008. According to the anti-virus protocol these recipients are divided into two groups as following： group A received a protocol of combination treatment of lamivudine with HBIG, and group B with combination treatment of adefovir with HBIG. With mean follow-up of 23.7 months, HBV recurrent rate was observed in overall and each group separately. Results A total of 195 liver transplant recipients were identified that met the study criteria. At the sixth and eleventh month after operation, HBV recurrence appeared in 2 recipients, each in two groups, which were due to LAM cessation and HBV mutation respectively. Recurrent rate was 0.6% in group A, 3.7% in group B and 1% in total. There was no significant difference in HBV recurrent rate between group A and B. Conclusion Lamivudine combined with HBIg should be considered as a reliable method in preventing HBV recurrence after liver transplantation. Better outcomes can be achieved by individual anti-virus protocol and HBIg administration according to HBV status in recipient.

关 键 词：肝移植 肤炎病毒 乙型 免疫球蛋白 复发 

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