受体相关肝移植术后乙肝复发的危险因素分析  

Risk factors of hepatitis B virus infection after liver transplantation related to the recipients

作　　者：贾亚男 李瀚 吕少诚[1] 朱继巧[1] 许文犁 李先亮[1] 贺强[1] Jia Yanan;Li Han;Lu Shaocheng;Zhu Jiqiao;Xu Wenli;Li Xianliang;He Qiang(Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital,Beijing,100000,China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆胰脾外科,北京100020

出　　处：《实用器官移植电子杂志》2021年第1期31-36,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家自然科学基金(81571554,81273270,81471590)。

摘　　要：目的本研究旨在探讨影响受体相关肝移植术后乙肝复发的危险因素。方法回顾性搜集、随访、分析北京朝阳医院2013—2019年7年中连续320例有乙肝病史并行肝移植手术治疗的患者的临床资料,搜集可能与乙肝复发有关的围术期参数,并对可能影响患者术后乙肝复发的危险因素进行分析。结果在320例患者中,原发疾病为乙肝所致肝恶性肿瘤患者178例,乙肝所致肝功能衰竭患者84例,乙肝肝硬化失代偿期患者58例。截止随访日期,共有25例患者发生乙肝复发,总体复发率为7.8%。患者的平均复发时间为19.7个月,术后1、3、5年乙肝复发率分别为3.0%、10.5%、11.5%。良性疾病和恶性肿瘤患者的1、3、5年乙肝复发率分别为0%、3.9%、3.9%和5.5%、16.6%、18.6%(P=0.001)。多因素分析显示,受体病因(RR=3.639,95%CI:1.138~11.637)、乙肝DNA复制量(RR=2.180,95%CI:1.362~3.489)和乙肝治疗史(RR=6.011,95%CI:1.769~20.421)是影响移植术后乙肝复发的独立危险因素。结论肝移植术后乙肝复发与其原发疾病、病毒复制活跃程度及术前抗病毒治疗有关,原发病为肝恶性肿瘤、乙肝DNA复制量高和既往未治疗乙肝的肝移植受体,术后乙肝复发的风险较高。Objective The aim of this study was to determine the risk factors associated with the recurrence of hepatitis B virus infection after liver transplantation related to the recipients.Methods Clinical data of 320 consecutive patients who had history of Hepatitis B and underwent liver transplantation in Beijing Chaoyang Hospital from 2013 to 2019 were retrospectively collected,followed and analyzed.The data which are probable information related to the recurrence of hepatitis B in the perioperative period were organized and analyzed.Results Among the 320 patients,178 patients had hepatic malignant tumor caused by hepatitis B,84 patients experienced liver failure caused by hepatitis B and 58 patients had decompensated liver cirrhosis.Recurrence of hepatitis B was diagnosed in 25 patients at the end of the follow-up date with an incidence rate of 7.8%.The mean duration of recurrence was 19.7 months.The 1-,3-and 5-year recurrence rate after surgery were 3.0%,10.5%and 11.5%.The 1-,3-and 5-year recurrence rate of hepatitis B of patients with benign liver disease and patients with hepatic malignant tumor were 0%,3.9%,3.9%and 5.5%,16.6%,18.6%(P=0.001)respectively.Multivariate analysis showed that the causes of primary disease(RR=3.639,95%CI:1.138~11.637),replications amount of HBV DNA(RR=2.180,95%CI:1.362~3.489)and the history of hepatitis B treatment(RR=6.011,95%CI:1.769~20.421)were the independent risk factors which affect the recurrence of hepatitis B after liver transplantation.Conclusion The primary disease,the activity level of hepatitis B replication and the antiviral treatment before surgery are associated with the recurrence of hepatitis B after liver transplantation.The recipients with malignant liver tumor,higher HBV DNA replication and without any antiviral treatment had a higher risk of hepatitis B recurrence after liver transplantation.

关 键 词：肝移植 乙型病毒性肝炎 复发 危险因素 

分 类 号：R512.62[医药卫生—内科学] R657.3[医药卫生—临床医学]