肝移植术后乙型肝炎病毒-S基因变异检测与临床意义  

Clinical significance of hepatitis B virus S gene mutation for recurrence of hepatitis B after liver transplantation

作　　者：焦作义[1] 张冬红[1] 李玉民[1] 罗长江[1] 严律南[2] 

机构地区：[1]兰州大学第二医院普外一科,兰州730030 [2]四川大学华西医院肝移植中心

出　　处：《中华肝脏病杂志》2014年第8期580-584,共5页Chinese Journal of Hepatology

摘　　要：目的通过对单中心肝移植术后乙型肝炎复发的监测和HBV-S基因变异的检测，旨在初步了解肝移植术后乙型肝炎复发患者S基因变异与乙型肝炎复发之间的关系。方法随访单中心,299例HBV相关肝病肝移植患者，荧光定量聚合酶链反应扩增乙型肝炎复发患者血清HBVDNA，采用Sanger酶学法检测HBV-S基因。用COX回归分析法分析乙型肝炎重发因素。结果肝移植患者术后共有12例发生乙型肝炎复发，其中2例发生了HBV—S基因变异，肝移植术后乙型肝炎复发患者S基因变异率为16．67％（2／12），T126I合并G145A变异和M133L变异患者各1例。Cox多因素分析提示：HBV-YMDD变异（P=0．01）、HBV-S基因变异沪=0．03）、治疗依从性下降沪=0．03）均是乙型肝炎复发的风险因素。结论HBV-S基因变异是可能导致HBV相关肝病肝移植术后乙型肝炎复发的原因之一，值得深人研究。Objective To examine the incidence of hepatitis B virus （HBV） S gene mutation in recipients with recurrent HBV infection after liver transplantation （LT） and to evaluate the clinical significance of these mutants. Methods Two-hundred-and-ninety-nine patients who received LT for HBV-related liver diseases in single centre were enrolled in the study and followed up. Serum HBV DNA was amplified by fluorescence quantitative polymerase chain reaction, and HBV-S gene mutation was detected by Sanger＇s enzymatic method. Results Twelve of the 299 patients developed recurrent HBV after LT, and 2 of these 12 carried a mutant of the HBV-S gene （incidence rate of 16.67%）. One of the patients had T126I and G145A mutations, and the other had a M133L mutation. Cox regression modelling identified the risk factors of HBV recurrence after LT as HBV-YMDD mutants （P = 0.01）, HBV-S mutants （P = 0.03） and compliance decrease （P = 0.03）. Conclusion HBV-S mutants may contribute to recurrence of HBV after LT, and the mechanism should be addressed in future studies.

关 键 词：肝移植 肝炎病毒 乙型 基因 

分 类 号：R512.62[医药卫生—内科学]