肝脏移植后乙肝复发的临床病理学研究  

Clinicopathological Study of Hepatitis B Recurrence after Liver Transplantation

作　　者：熊璐[1] 郭晓东[1] 高银杰[1] 张红萍[1] 章方莉[1] 张敏[1] 李进[1] 

机构地区：[1]解放军第302医院,北京100039

出　　处：《现代生物医学进展》2013年第9期1722-1724,共3页Progress in Modern Biomedicine

基　　金：国家"十二五"重大专项(2012ZX10002003-004-006)

摘　　要：目的:探讨乙肝终末期肝移植术后乙肝复发的组织病理学特征。方法:回顾性研究分析18例移植术后乙肝复发病人的肝脏病理学和血清学检查资料。结果:14例病人在术后抗病毒治疗过程中乙肝病毒出现YMDD变异。4例病人肝癌复发行化疗后乙肝复发。14例病毒发生YMDD变异病人将恩替卡韦加阿德福韦替换拉米夫定治疗,4例肝癌复发者化疗后用恩替卡韦治疗。经治疗后,14例病人肝脏功能渐近恢复,乙肝病毒DNA拷贝数<102 U/ml,4例肝癌复病人最终死亡。肝移植术乙肝复发后肝脏病理呈现出肝细胞坏死,纤维化增生和炎症反应。血清学检查呈现出乙肝病毒DNA复制增多。结论:乙肝终末期肝移植术后乙肝复发时肝组织坏死、炎症反应以及纤维化增生与乙肝病毒拷贝数相关。术后检测乙肝病毒以及有效及时的抗乙肝病毒治疗能明显改善病人的预后。Objective： To investigate the clinicopathological characteristics of hepatitis B recurrence after live transplantation in end-stage hepatitis patients. Methods： The clinical serous and pathological data of 18 patients who had hepatitis B recurrence after liver transplantation were studied retrospectively. Results： 14 patients got YMDD mutation during anti-hepatitis B virus after transplantation. 4 patients got hepatitis B recurrence after receiving chemotherapy for liver cancer recurred. 14 patients were treated with entecavir and adefovir. 4 patients were treated with entecavir. After anti-virus treatment, liver function of 14 patients changed to the normal standard and the copy ofHBV DNA was 〈102 U/mL. 4 patient with liver cancer recurred were died. The live histological changes of patient with recurring hepatitis B after transplantation included hepatoceUular necrosisl fibrosis and inflammation. The copies of HBV DNA in serum were increased. Conclusions： The pathological change including hepatocellular necrosis, fibrosis and inflammation was closely related to the copies ofHBV DNA. DNA of hepatitis B virus monitored and anti virus treated immediately and effectively can improve the prognosis of the patients after transplantation.

关 键 词：肝移植 复发 乙肝 组织病理学 

分 类 号：R575.31[医药卫生—消化系统] R512.62[医药卫生—内科学]