拉米夫定对肝移植术后乙肝病毒再感染的预防作用

Prophylactic Effect of Lamivudine Monotherapy Against Hepatitis B Recurrence Following Liver Transplantation

目的 探讨单一应用拉米夫定预防良性乙肝相关性肝病肝移植术后乙肝病毒再感染的疗效。方法 总结单一应用拉米夫定预防肝移植术后生存时间大于3个月的31例良性乙肝相关性终末期肝病患者的乙肝病毒再感染情况，同时检测肝移植手术前、后血清及肝穿刺组织乙肝表面标志物及HBVDNA的变化。结果 31例患者随访时间平均为38．2个月（3．2～70．2个月），随访期间死亡8例。乙肝病毒总的再感染率为19．4％（6／31），术后1、3、5年乙肝再感染率分别为7．1％（2／28）、16．0％（4／25）及26．1％（6／23），生存率分别为87．1％（27／31）、80．6％（25／31）及66．1％（20．5／31）。术前HBeAg和HBVDNA的清除率分别为54．5％（6／11）和50．0％（5／10）。术前HBVDNA和HBeAg阳性患者术后乙肝病毒再感染率高。结论 拉米夫定可以有效地预防良性乙肝相关性肝病患者肝移植术后乙肝病毒的再感染；术前应尽可能使HBVDNA和HBeAg转阴。

Objective To investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. Methods Thirty-one patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tis- sues in all patients were evaluated before and after operation. Results Total HBV recurrence rate was 19. 4% （6/31） during average 38.2 months （3. 2-70. 2 months） follow up. HBV recurrence rate was 7. 1% （2/28）, 16. 0% （4/25）, 26.1% （6/23） and survival rate was 87.1% （27/31）, 80.6% （25/31）, 66.1% （20.5/31） after 1-, 3- and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5% （6/11） and HBV DNA 50.0% （5/10） positive patients convert to negative respectively. Conclusion Preoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV reinfection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.