乙型肝炎相关性终末期肝病患者肝移植后乙型肝炎病毒感染复发的治疗  

Treatment of HBV recurrence after liver transplantation for HBV related liver diseases

作　　者：章拔翠 陈虹[1] 王旭[1] 范铁艳[1] 李俊[1] 张庆[1] 陈新国[1] 

机构地区：[1]武警总医院器官移植研究所,北京100039

出　　处：《中华器官移植杂志》2015年第4期209-212,共4页Chinese Journal of Organ Transplantation

基　　金：国家高技术发展计划“863计划”项目（2012AA022409）

摘　　要：目的分析影响乙型肝炎相关终末期肝病患者接受肝移植后乙型肝炎病毒（HBV）感染复发（以下简称HBV复发）情况，总结HBV复发后的治疗经验。方法回顾性分析2002年9月至2007年2月间650例因乙型肝炎相关性终末期肝病接受肝移植的受者临床资料。结果650例受者术后共有25例发生HBV复发，复发率为3．85％（25／650）；经核苷（酸）类似物治疗后，所有受者肝功能均恢复至正常。3例受者失随访。2例因肿瘤复发而死亡，1例因肿瘤复发行再次肝移植后死亡。11例血清学HBV表面抗原（HBsAg）仍阳性，其中10例受者HBVDNA已转阴。1例发展为肝炎后肝硬化失代偿接受再次肝移植后HBsAg转阴，7例接受核苷（酸）类药物治疗后HBsAg滴度逐渐下降至较低水平，加用大剂量乙型肝炎免疫球蛋白（HBIG）连续静脉滴注3～5d，实现了HBV表面抗体（抗HBs）的血清学转换。结论肝移植术后停用抗HBV药物及HBV变异是导致HBV复发的重要原因。HBV复发后换用或加用核苷（酸）类似物可有效控制HBV复制。当HBsAg下降至较低水平时，加用大剂量HBIG可实现抗HBs血清学转换。Objective To analyze the HBV recurrence and summarize the experiences in treatment of HBV recurrence after liver transplantation for HBV related liver diseases. Method A total of 650 patients subject to liver transplantation for HBV related liver diseases from September 2002 to February 2007 were included, and the clinical data were retrospectively analyzed. Result Twenty-five （3. 85%） of 650 patients experienced HBV recurrence. All liver functions recovered to normal after nucleoside or nucleotide analogs treatment. Two cases lost to follow-up, 2 cases were died of tumor recurrence, and 1 case died of tumor recurrence after re-transplantation. Eleven cases were positive for serum HBsAg, and HBV DNA was converted to undetectable levels in 10 cases. One case developed to decompensated liver cirrhosis, and HBsAg was negative after re-transplantation. In 7 cases, after nucleos（t）ide analogs treatment, HBsAg titer was decreased gradually to a lower level, and continuous intravenous drip of large doses of HBIG for 3 to 5 days achieved anti-HBs seroconversion. Conclusion Nucleos（t） ide analogs can effectively suppress viral replication of HBV recurrence after liver transplantation. When the HBsAg titer is decreased to a lower level, large doses of HBIG can achieve anti-HBs seroconversion.

关 键 词：肝移植 乙型肝炎病毒 复发 核苷类似物 乙型肝炎免疫球蛋白 

分 类 号：R512.62[医药卫生—内科学]