非活动性乙型肝炎表面抗原携带者肾移植后的病毒再激活及预防  

Clinical observation of HBV reactivation and prevention in renal allograft recipients with inactive HBsAgcarriers

作　　者：兰天飙[1] 任星峰[1] 陈燕[1] 彭隽[1] 杨成[1] 邵紫韫[1] 

机构地区：[1]广州军区武汉总医院肾脏病科,武汉430070

出　　处：《中华器官移植杂志》2012年第10期602-605,共4页Chinese Journal of Organ Transplantation

摘　　要：目的观察非活动性乙型肝炎表面抗原（HBsAg）携带者肾移植后乙型肝炎病毒（HBV）的再激活状况，探讨其预防措施。方法回顾性分析88例非活动性HBsAg携带者肾移植前后的临床资料。88例术前肝功能均正常，血清HBsAg阳性，HBVDNA〈10^6拷贝／L；移植后均采用他克莫司（或环孢素A）＋吗替麦考酚酯（MMF）＋泼尼松预防排斥反应。88例中，56例采用核苷（酸）类似物进行预防性抗病毒治疗，其中采用拉米夫定（LAM）者31例（LAM组），采用恩替卡韦（ETV）者25例（ETV组）；另32例未行预防性抗病毒治疗，仅给予肌苷、葡醛内酯等常规护肝治疗（对照组）。观察三组患者HBV再激活的发生率、肝功能情况、对治疗的反应以及肝组织的病理学变化。结果观察期内HBV再激活的发生率，LAM组为45．2%，ETV组为28．0％，均较对照组的84．4％显著降低（P〈0．01），且接受预防性治疗者HBV再激活的发生时间晚，肝功能损害较轻，HBVDNA的载量峰值低（P〈0．05）。LAM组HBV再激活14例，其中10例发生在服用LAM的过程中，改用ETV治疗2个月左右，7例血清HBVDNA水平降至检测线下；另4例发生在用药不足1年，未遵医嘱盲目停药者中，再次采用原方案抗病毒治疗，3例血清HBVDNA水平降至检测线下，1例效果不明显。对照组HBV再激活27例，14例因此接受了核苷（酸）类似物抗病毒治疗，经治疗10例HBVDNA水平降至检测线下。肝组织学检查符合纤维化淤胆性肝炎改变者9例，其中8例发生在对照组，仅1例发生在LAM组盲目停药者。结论LAM和ETV的预防性使用可降低非活动性HBsAg携带者肾移植后HBV的再激活率，减轻肝损伤程度，减少纤维化淤胆性肝炎的发生。Objective To investigate the HBV reactivation status and clinic outcomes in the renal allograft recipients with inactive HBsAg carriers, and explore the preventive measures. Methods A retrospective analysis of clinical manifestation was processed in 88 cases of inactive HBsAg carriers before and after renal transplantation. Preoperative liver function in all cases was normal and serum HBsAg positive, HBV DNA^106 copies/L. Tacrolimus （or cyclosporine A） ＋ mycophenolate mofetil （MMF） ＋ prednisone were given in prevention of rejection after transplantation. In 88 cases, 56 cases were given nucleoside analogues （acid） for prophylactic antiviral therapy, in which 31 cases were given lamivudine （LAM） （LAM group）, 25 cases were given entecavir （ETV） （ETV group） ; The rest 32 cases were not given prophylactic antiviral therapy, only receiving routine liver-protecting therapy （inosine, glucurolactone） （control group）. Incidence of HBV re-activation, liver function, response to treatment and the pathological changes of hepatic tissue were observed. Results During the follow-up period, the incidence of HBV reactivation in LAM group and ETV group was 45.2%and 28.0% respectively, significantly lower than in control group （84.4%, P 〈0. 05）. In prophylactic treatment groups, HBV reactivation occurred later, liver function damage was milder, and HBV DNA load peak was lower （P〈0. 05）. In LAM group, HBV reactivation occurred in 14 cases, including 10 cases occurred during administration of LAM, and ETV treatment was given for about 2 months, serum HBV DNA levels in 7 cases were under detection line; in the rest 4 cases, HBV reactivation occurred in patients with treatment less than 1 year and noncompliance, who withdrew medicine blindly. After the original scheme of antiviral therapy wasdone, serum HBV DNA levels in 3 cases were under detection line, and the effect was not obvious in one case. In control group, HBV reactivation occurred in 27 cases. Fourteen cases therefore accep

关 键 词：肾移植 肝炎病毒  乙型 

分 类 号：R699[医药卫生—泌尿科学] R51[医药卫生—外科学]