肝移植术后乙型肝炎病毒再感染的防治策略  

Prophylaxis of hepatitis B virus reinfections after liver transplantation

作　　者：窦逾常[1] 孙然[2] 刘明晖[3] 

机构地区：[1]吉林大学中日联谊医院中医科,吉林长春130033 [2]吉林大学中日联谊医院组织标本库,吉林长春130033 [3]吉林大学中日联谊医院全科,吉林长春130033

出　　处：《中华医院感染学杂志》2013年第16期3935-3936,共2页Chinese Journal of Nosocomiology

基　　金：吉林省中医药管理局中医药科技项目(2012-139)

摘　　要：目的探讨肝移植术后乙型肝炎病毒再感染的发病因素,以及使用拉米夫定和小剂量乙型肝炎免疫球蛋白的治疗效果。方法对2010年1月-2011年1月进行肝移植手术、并符合研究标准的患者45例进行回顾性分析;根据给药方法的不同,分为单独使用拉米夫定治疗对照组和拉米夫定联合小剂量乙型肝炎免疫球蛋白进行治疗联合组,两组分别为21例和24例患者;所有患者治疗后均给予随访,观察肝移植术后乙型肝炎病毒再感染情况,两组以P<0.05为差异有统计学意义。结果联合组术后乙型肝炎病毒再感染发生率为16.67%,显著低于对照组的47.61%,两组差异有统计学意义(P<0.05),术前HBeAg阳性和HBV-DNA阳性对照组发生率为100.00%,联合组发生率为50.00%,HBV-DNA定量值>103拷贝/ml的患者,比较HBeAg和HBV-DNA阴性患者获得乙型肝炎病毒再感染的风险增大,差异有统计学意义(P<0.05)。结论肝移植术前HBeAg阳性、HBV-DNA阳性且定量值>103拷贝/ml是乙型肝炎病毒再感染的重要因素,而拉米夫定联合小剂量乙肝免疫球蛋白治疗和预防肝移植术后乙型肝炎病毒再感染效果较好,具有良好的临床应用价值。OBJECTIVE To investigate influencing factors and prophylaxis of hepatitis B virus（HBV）reinfection after liver transplantation and the clinical effect of using lamivudine and low-dose of hepatitis B immune globulin for the treatment of HBV reinfections.METHODS Totally 45patients with liver transplantation were selected for retrospective analysis from Jan 2010to Jan 2011in the hospital.45patients were divided into the control group（Lamivudine only,21cases）and the combination group（lamivudine combined with hepatitis B immunoglobulin,24cases）according to therapeutic methods.All patients were followed up in order to inspect situation of HBV reinfections after liver transplantation.RESULTS The incidence rate of HBV reinfections after liver transplantation of the combination group was 16.67%,significantly lower than 47.61% of the control group,the difference was significant（P0.05）.The risk increased of HBV reinfections after liver transplantation when HBeAg（＋）,HBV-DNA（＋）（100.00%in the control group and 50.00%in the combination group）and HBV-DNA level greater than 103copies/ml of patients before liver transplantation as compared with that patients of HBeAg（-）and HBV-DNA（-）,the difference was significant（P0.05）.CONCLUSIONThe HBeAg（＋）,HBV-DNA（＋）and HBV-DNA levels greater than 103 copies/ml are the important factors of HBV reinfections after liver transplantation.The lamivudine combined with hepatitis B immunoglobulin can prevent beforehand effectually HBV reinfections after liver transplantation,and it has a satisfactory clinical application value.

关 键 词：肝移植 乙型肝炎病毒 再感染 防治策略 

分 类 号：R512.62[医药卫生—内科学]