乙型肝炎相关疾病肝移植术后患者体内HBVDNA和共价闭合环状DNA的检测及其临床意义  

Deteclion of total and eovalently closed circular HBV DNA in liver transplant recipients due to HBV-associated liver diseases

作　　者：段斌炜[1] 卢实春[2] 邱宁[3] 李蕊[3] 刘学恩[3] 

机构地区：[1]首都医科大学附属北京佑安医院普通外科中心,100069 [2]解放军总医院肝胆医院肝胆外科数字重点实验室军事进修医学院 [3]北京大学医学部基础医学院微生物学系和传染病中心

出　　处：《中华肝脏病杂志》2015年第8期594-598,共5页Chinese Journal of Hepatology

基　　金：首都卫生发展科研专项基金（首发2011-2018-03）;科技部支撑计划项目（2012BA106801）

摘　　要：目的研究乙型肝炎相关疾病肝移植术后长期生存患者体内HBVDNA和共价闭合环状DNA（CCCDNA）的存在状况，并探讨其临床意义。方法采用实时荧光定量聚合酶链反应法（RT-PCR）检测因乙型肝炎相关疾病而行肝移植的成人患者体内[包括血浆、肝组织和外周血单核细胞（PBMCs）]的HBVDNA和teeDNA的存在状况。计量资料均数间的比较采用t检验，计数资料的比较采用x^2检验。结果60例患者参加了本研究，其中男性48例，女性12例，年龄（52．98±9．40）岁，术后随访中位时间72（25～128）个月。共获得外周血59份，肝穿刺组织标本41份，检测结果显示59例患者血浆中54（91．5％）例未检测到HBVDNA，5例为低于检测下限（20IU／L）；在PBMCs中，有4例患者检测到HBVDNA，但均未检测到CCCDNA；在肝组织内，有5例患者检测到HBVDNA，其中3例检测到CCCDNA的存在。随访结果显示有1例患者发生了乙型肝炎复发，其PBMCs内检测到HBVDNA，同时该患者存在HBV基因变异。结论尽管有术后预防HBV再感染的联合方案，仍有少部分长期生存的患者体内可以检测到微量HBVDNA或（和）cccDNA，这部分患者属于乙型肝炎复发高风险人群，长期使用乙型肝炎免疫球蛋白和抗病毒药物是必要的。Objective To investigate the levels of hepatitis B virus （HBV） total DNA and covalently closed circular （ccc） DNA in liver transplant recipients due to Hl3V-associated liver diseases and determine their clinical significance. Methods Sixty patients undergoing liver transplantation （LT） due to HBV-associated liver diseases were enrolled for the study. Levels of HBV total and ccc DNA in plasma, liver and PBMCs were measured by RT-PCR. Results The ratio of male：female participants was 48：12. The mean age was 52.98±9.40 years old, and the median duration post-LT was 72 （25-128） months. 59 of the patients had no detectable HBV DNA in plasma. Four patients had detectable levels of total HBV DNA in PBMCs, but no detectable ccc DNA. Five patients had detectable levels of total HBV DNA in liver, and two of those also had detectable levels ofccc DNA. One patients who had detectable HBV DNA in PBMCs suffered HBV recurrence. Conclusion The liver transplant recipients with detectable levels of HBV total and ccc DNA in PBMCs and liver should be considered high risk for HBV recurrence following LT.

关 键 词：肝移植 肝炎 乙型 慢性 肝炎病毒 乙型 共价闭合环状DNA 

分 类 号：R657.3[医药卫生—外科学]