异基因造血干细胞移植术后乙型肝炎的临床特点

Clinical features of the patients with hepatitis B after allo-genetic hemopoietic stem cell transplantation

目的探讨异基因造血干细胞移植患者乙型肝炎的临床表现、病理、自然史。方法总结合并HBV感染的异基因造血干细胞移植患者10例,其乙型肝炎发病时临床和肝组织病理资料。血清丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(GGT)采用速率法,血清总胆红素(TBIL)采用终点比色法检测;乙型肝炎病毒血清标志物采用酶免疫测定(EIA),HBVDNA定量测定采用聚合酶链反应(PCR)试剂盒。其中8例进行了肝组织活检。结果(1)5例患者有慢性乙型肝炎病史,5例患者有乙型肝炎家族史,4例患者有HBV暴露史。(2)移植前10例患者肝功能指标包括ALT、TBIL、GGT均正常,而在乙型肝炎发作时上述指标均显著升高。(3)移植前受者的乙型肝炎免疫性检测为1例患者HBsAg阳性、HBeAg阳性、抗-HBc阳性;1例患者抗-HBs阳性、抗-HBc阳性;3例患者仅抗-HBc阳性;4例患者HBsAg阳性、抗-HBe阳性、抗-HBc阳性;1例患者仅抗-HBs阳性。(4)3例患者肝脏病理学诊断为纤维化瘀胆性肝炎,4例患者诊断为慢性乙型肝炎,1例患者诊断为急性乙型肝炎。(5)在随访终点时,5例患者死于重型肝炎,1例患者死于肺炎,3例患者发展为慢性乙型肝炎,1例患者痊愈。结论(1)HSCT术后乙型肝炎患者常有乙型肝炎病史、乙型肝炎家族史或HBV暴露史。(2)HSCT乙型肝炎患者的临床特点、病理、自然史不同于正常免疫状态的乙型肝炎患者。

Objective To investigate clinical signs, liver histology and natural history of allogenetic hemopoietic stem cell transplantation patients with hepatitis B. Methods Clinical data of 10 cases with hepatitis B after allo-genetic hemopoietic stem cell transplantation were summarized and analyzed. These cases were subjected to liver biochemical tests, HBV serologic assays （ELISA） and HBV DNA assays. 8 patients were taken liver biopsy. Results Five patients had hepatitis B history , five patients had hepatitis B family history and four patients had exposed to HBV. Liver functions were remarkably abnormal for patients with hepatitis B after allo-genetic hemopoietic stem cell transplantation. Three patients were diagnosed fibrosing cholestatic hepatitis, four patients were diagnosed chronic hepatitis B and one patients was acute hepatitis B by liver histology. Five patients died for liver failure and three patients developed chronic hepatitis B in the end of follow-up. Conclusions （ 1 ） Most patients with hepatitis B after HSCT had hepatitis B history or hepatitis B family history or had exposed to HBV. （2） It may be different for the clinical and liver histological data and natural history of hepatitis B between hemopoietic stem cell transplantation patients with hepatitis B and immunocompetent patients.