肝移植术后乙型肝炎病毒再感染的病因与预后  

Etiology and prognosis of hepatitis B reinfection after orthotopic liver transplantation

作　　者：丁海[1] 赵伟[1] 易永祥[1] 杨永峰[1] 端木浩[1] 刘俊卯[1] 

机构地区：[1]东南大学附属南京市第二医院普外科,南京210003

出　　处：《胃肠病学和肝病学杂志》2011年第10期929-932,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：江苏省医学重点学科经费(XK200730);南京市卫生局医学科学发展重大项目计划经费资助

摘　　要：目的了解肝移植后乙肝复发的原因及对预后影响。方法对终末期肝病患者肝移植前后的HBV DNA水平、HBV变异情况和HBV变异前后肝功能变化进行随访检测;术后肝功能和HBV DNA水平出现异常变化时,做肝脏组织活检。所有患者常规术后拉米夫定和乙肝免疫球蛋白治疗。结果 2004年4月～2005年12月20例终末期肝病患者在我院进行了肝移植治疗,其中12例为乙肝肝硬化,8例为乙肝慢重肝合并急性肝衰,术后3例死于移植肝无功能,3例失访,14例随访了60～84个月不等,术后1年内,有6例患者出现乙肝病毒变异,其中3例病理证实乙肝复发,且均为乙肝慢重肝合并急性肝衰患者,2例术前HBV DNA分别为>102copies/mL、>106copies/mL,另外3例乙肝肝硬化仅仅表现乙肝病毒变异,无肝炎复发。结论肝移植术后接受拉米夫定和乙肝免疫球蛋白治疗者,病毒变异是乙肝复发的主要原因,慢重肝合并急性肝衰、术前HBV DNA阳性的病人,随访时应该特别注意术后乙肝的复发。Objective To investigate the etiology and prognosis of hepatitis B virus （HBV） reinfection after ortho- topic liver transplantation （OLT）. Methods Levels of HBV DNA, HBV mutation and liver function HBV mutation pre/post-operation in OLT patients were checked by followed up observation. All patients received standard therapy of lamivudine plus HBIG. Results From April 2004 to December 2005, 20 patients （ age range 28 - 60, median 46.9 ） accepted OLT in our center, 12 cases were HBV-related end-stage cirrhosis, 8 cases were HBV-related chronic acute liver failure （ chronic severe hepatitis） , and 3 cases died of liver failure post-OLT. Fourteen cases were followed up 60 84 months, 6 cases of them appeared HBV mutation. 3 cases HBV recurred and all of them were HBV-related chronic severe hepatitis within one year post-operation. Conclusion HBV mutation is the primary reason for HBV reinfection in the patients treated with Lamivudine and HBIG post-OLT. Patients with HBV-related chronic severe hepatitis and positive serum HBV DNA status pre-operation should be followed up with care for HBV reinfection.

关 键 词：乙肝再感染 肝移植 病因 预后 

分 类 号：R512.62[医药卫生—内科学]