“大三阳”乙肝病人肝移植后抗HBV治疗远期效果分析  

Long-term prevention of virus recurrence among recipients with HBV active replication following liver transplantation

作　　者：戴军[1] 卢实春[4] 严律南[1] 李波[1] 赖威[1] 赵冀[1] 金圣杰[1] 文天夫[1] 赵纪春[1] 曾勇[1] 陶传敏[2] 张秀辉[3] 

机构地区：[1]四川大学华西医院普外科,成都610041 [2]四川大学华西医院临床微生物学实验室,成都610041 [3]四川大学华西医院病理科,成都610041 [4]首都医科大学附属北京佑安医院肝胆外科

出　　处：《中华肝胆外科杂志》2009年第2期106-109,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：本课题受937科教攻关项目（2003CB515504）;国家自然科学基金（30671977）资助

摘　　要：目的通过长期观察大三阳乙肝病人肝移植后在LAM或（和）HBIG预防下其体内HBV标志物的变化，探讨乙肝复发的可能机制，为预防复发及个体化治疗寻找切入点。方法ELISA、HBV—DNA荧光定量、免疫组化定期检测术前术后各期血清及其供肝活检组织，回顾性观察55例大三阳病人随访中HBV标志物的变化。结果平均随访69．14个月，共12例乙肝再感染／复发，LAM＋HBIG组乙肝复发比率为4．8％（2／42），而LAM组为76．9％（10／13）（P=0．000）。联合组1、2、3、4年生存率分别为100％、97．1％、92．7％、92．7％；单用组1、2、3、4年生存率分别为76．9％、69．2％、53．8％、46．2％（P=0．000）；前者2年内乙肝复发率〈3％，后者1、2、3、4年复发率分别为16．1％、41．3％、66．4%、66．4%（P=0．000）。结论HBIG联合核苷（酸）类似物作为当前最佳的乙肝复发预防方案明显地降低了复发率，治疗依从性差及病毒的自身状态是中国肝移植后乙肝再感染／复发的主要原因。根据治疗过程中病毒自身状态的变化及时调整用药将有助于进一步减少术后乙肝复发。Objective To investigate the long-term prophylactic outcome in recipients with HBV active replication under LAM or/and HBIG prophylaxis after liver transplantation. Methods The liver biopsy specimens and serum samples were collected during the follow-up. ELISA and chemiluminesent microparticle immunoassay, HBV-DNA fluorescent quantification, immunohistochemisty and HBV-DNA in situ hybridization were performed for analysis. The alteration of HBV markers in serial biopsy and sera of 55 recipients were investigated retrospectively. Results The mean time of follow-up was 69. 14 months. Twelve cases had hepatitis B virus reinfection after transplantation. The accumulated ratio of hepatitis B virus reinfection was 4.8 % （2/42）in LAM＋ HBIG group and 76.9%（10/13） in LAM monopropyhlaxis group （P=0. 000）. The 1-,2-,3- and 4-y survival rates in combined prophylaxis group were 100%, 97.1%, 92.7% and 92.7%, respectively. The 1-,2-,3- and 4-yr survival rates in LAM mono prophylaxis group were 76.9%, 69.2%, 53.8% and 46.2%, respectively （P= 0. 000）. The rates of hepatitis B virus reinfection in combination prophylaxis group （1-,2-,3- and 4-yr recurrence rates of 2.4%, 2.4%, 2.4% and 8.5%, respectively） was markedly lower than those in mono prophylaxis group（1 , 2 , 3 and 4 yr recurrence rates of 16.1%, 41.3%, 66.4% and 66.4%, respectively） （ P= 0. 000）. Conclusion Currently HBIG combined with LAM is an optimal prophylatic protocol to reduce the hepatitis B virus reinfection rate. However, poor compliance of recipients to a prescribed course of prophylaxis as well as viral status itself is still the main cause of hepatitis B virus reinfection after liver transplantation in China. Compliance education and adjusting the prophylatic protocols according to the viral alteration after liver transplantation may help to further decrease the hepatitis B virus reinfection rate.

关 键 词：肝移植 乙肝标志物 再感染 复发 

分 类 号：R686[医药卫生—骨科学]