小剂量人乙型肝炎免疫球蛋白结合恩替卡韦对肝移植术后乙型肝炎病毒再感染的防治效果  

Effect of low-dose human hepatitis B immunoglobulin combined with entecavir on hepatitis B virus reinfection in patients after liver transplantation

作　　者：施海虹 黄静[1] 金洁 任绿梅 傅建英[1] SHI Hai-hong;HUANG Jing;JIN Jie;REN Lyu-mei;FU Jian-ying(Ningbo Medical Center Lihuili Hospital East Hospital,Ningbo,Zhejiang 315000,China)

机构地区：[1]宁波市医疗中心李惠利医院东部院区肝胆胰外科一,浙江宁波315000

出　　处：《中华医院感染学杂志》2021年第11期1681-1685,共5页Chinese Journal of Nosocomiology

基　　金：浙江省科研基金资助项目(2018214101)。

摘　　要：目的探究小剂量人乙型肝炎免疫球蛋白(HBIG)结合恩替卡韦(ETV)对肝移植术后乙型肝炎病毒(HBV)再感染的防治作用。方法将2012年1月-2015年6月于宁波市医疗中心李惠利医院东部院区行肝移植且使用ETV预防HBV再感染的41例患者作为对照组,2015年7月-2019年1月使用ETV联合小剂量HBIG预防HBV再感染的115例肝移植患者作为联合组,均至少随访18个月,定期复查乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(HBsAb)、乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(HBeAb)及乙型肝炎核心抗体(HBcAb)及HBV DNA,统计HBV再感染情况;术后再感染者均行络氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸(YMDD)基因变异筛查,观察YMDD变异情况,并记录治疗不良反应发生情况。结果联合组移植术后HBV再感染率为0.87%低于对照组(P<0.05);联合组术后不同时间HBsAb抗体滴度均高于对照组(P<0.05);对照组YMDD变异率为11.11%高于联合组,但差异无统计学意义(P=0.159);术前HBeAg(+)、术前HBV-DNA(+)患者HBV再感染率(13.33%、10.98%)均高于术前HBeAg(-)、术前HBV-DNA(-)患者(P<0.05)。结论小剂量HBIG联合ETV防治肝移植术后HBV再感染效果优于单独应用ETV,安全有效,可减少HBV再感染率,提高HBsAb抗体滴度。OBJECTIVE To explore the effect of low-dose human hepatitis B immunoglobulin(HBIG)combined with entecavir(ETV)on the prevention and treatment of hepatitis B virus(HBV)reinfection after liver transplantation.METHODS Totally 41 patients who underwent liver transplantation and were treated with ETV for preventing HBV reinfection in Eastern Branch of Ningbo Medical Center Lihuili Hospital from Jan.2012 to Jun.2015 were selected as the control group,and 115 patients treated with ETV combined with low-dose HBIG for preventing HBV reinfection from Jul.2015 to Jan.2019 were assigned as the combined group.All subjects were followed up for at least 18 months.The hepatitis B surface antigen(HBsAg),hepatitis B surface antibody(HBsAb),hepatitis B e antigen(HBeAg),hepatitis B e antibody(HBeAb),hepatitis B core antibody(HBcAb)and HBV DNA were regularly examined to statistically analyze the situation of HBV reinfection.All patients who were re-infected after operation were screened for tyrosine-methionine-asparaginic acid-asparaginic acid(YMDD)gene mutation,the YMDD mutation was observed,and the occurrence of adverse treatment reactions was recorded.RESULTS The HBV reinfection rate after transplantation in the combined group was 0.87%,significantly lower than that in the control group(P<0.05).The HBsAb antibody titers in the combined group were significantly higher than those in the control group at different times after operation(P<0.05).YMDD mutation rate in the control group was 11.11%,higher than that in the combined group,but the difference was not significant(P=0.159).The HBV reinfection rates of preoperative HBeAg(+)and preoperative HBV-DNA(+)patients(13.33%,10.98%)were significantly higher than those of preoperative HBeAg(-)and preoperative HBV-DNA(-)patients(2.08%,1.35%)(P<0.05).CONCLUSION Low-dose HBIG combined with ETV was more effective than ETV alone in preventing and treating HBV reinfection after liver transplantation.It was safe and effective.Also,it can reduce HBV reinfection rate,and increase the HBsAb antibody

关 键 词：乙型肝炎病毒 肝移植 恩替卡韦 人乙型肝炎免疫球蛋白 再感染 

分 类 号：R512.62[医药卫生—内科学]