肝移植术后乙型肝炎病毒再感染的预防与诊治.doc

肝移植术后乙型肝炎病毒再感染的预防与诊治 作者：夏杰,杨占宇,陈佳,廖睿 作者单位：400038 重庆，第三军医大学西南医院全军感染病研究所(夏杰、陈佳、张南、周吉军、王宇明)，全 军肝胆外科研究所(杨占宇、廖睿、郭鹏) 【摘要】 目的 探讨肝移植术后HBV再感染的预防与诊治。方法 回顾性分析1999年8月至2004年12月98例肝移植患者临床资料。其中40例术后采用拉米夫定(lamivudine,LAM)单用方案预防HBV再感染，58例采用LAM＋乙型肝炎免疫球蛋白(HBIg)联用方案。对HBV再感染者予以阿德福韦(adefovir,ADV)抗病毒治疗。结果 17例肝移植患者出现HBV再感染，其中14例明确存在YMDD变异。术前血清HBV DNA阳性者术后2年HBV再感染率显著高于阴性者(P＜0.05)，前者术后采用LAM＋HBIg联合预防者其HBV再感染率显著低于单用LAM预防者(P＜0.05)，而后者术后LAM单用和LAM＋HBIg联用两组之间差异无统计学意义(P＞0.05)。15例HBV再感染者改用ADV治疗后，13例(86.7%)于治疗后1～3个月HBV DNA转阴。结论 术前降低血清HBV DNA水平和术后LAM＋HBIg联合预防方案能有效降低肝移植术后HBV再感染率。对术前HBV DNA阴性者，术后可选用LAM单药预防方案。ADV能够有效地治疗肝移植术后HBV再感染，抑制HBV变异株的复制。 【关键词】 肝移植； 乙型肝炎病毒再感染； 乙型肝炎免疫球蛋白 　　Prevention and treatment of HBV reinfection after liver transplantation 　　XIA Jie, YANG Zhanyu, CHEN Jia, LIAO Rui, ZHANG Nan, GUO Peng, ZHOU Jijun, WANG Yuming.*Department of Infectious Disease, Southwest Hospital, Third Military Medical University, Chongqing 400038, China　Corresponding author: WANG Yuming, Email: wym417@ 【Abstract】 Objective To study the prevention and treatment of HBV reinfection after liver transplantation. Methods A retrospective study was carried out on 98 patients who received orthotopic liver transplantation (OLT) from August 1999 to December 2004. Fiftytwo patients were HBV DNApositive and 46 HBV DNAnegative. All patients were divided into 4 groups: Group A ［HBV DNApositive patients treated by lamivudine (LAM), n=21］, Group B (HBV DNAnegative patients treated by LAM, n=19), Group C ［HBV DNApositive patients treated by LAM+ Hepatis B immunoglobulin (HBIG), n=31］ and Group D (HBV DNAnegative patients treated by LAM+HBIG, n=27). Adefovir dipivoxil (ADV) was administered to those patients who developed LAMresistant HBV reinfection (YMDD). Results Of all, 17 patients developed HBV reinfection after OLT but 14 of them were identified to be LAMresistant HBV reinfection. The 2year HBV reinfection rate was higher in HBV DNApositive patients than HBV D