肝移植术后预防乙型肝炎病毒再感染的策略

Prevention and treatment of hepatitis B virus reinfection after liver transplantation

目的探讨预防肝移植术后乙型肝炎病毒(HBV)再感染的综合策略。方法对术前存在HBV感染的130例肝移植患者进行前瞻性研究,采用肌肉注射剂型乙型肝炎免疫球蛋白(IMHBIg)联合口服拉米夫定(lamivudine)作为预防术后HBV再感染的治疗方案;术后监测HBV再感染的情况。结果在130例患者中,128例术后HBsAg转为阴性,检测血清HBsAb呈阳性。平均随访12·2个月,8例出现HBV再感染,再感染率为6·3%;术前HBeAg阳性者再感染率为14·3%,阴性者4·0%,两组间差异有统计学意义(P<0·05);术后第一天HBsAg阳性者再感染率为21·1%,阴性者3·7%,两组间差异有统计学意义(P<0·05)。结论拉米夫定联合肌肉注射剂型的人乙型肝炎免疫球蛋白可有效预防肝移植术后HBV再感染;术前血清HBeAg阳性以及术后第一天HBsAg者是术后HBV复发的高危因素。

Objective To investigate the risk factors and treatment of hepatitis B virus （HBV） reinfection after liver transplantation. Methods Patients with HBV related end-stage liver disease underwent liver transplantation in our center, and received the combination of intramuscular hepatitis B virus immunoglobulin and oral lamivudine as prophylaxis for HBV reinfection. HBV reinfection cases were monitored after the transplantation. Results HBsAg disappeared and HBsAb was detectable in 128 of total 130 patients. The median follow-up period was 12.2 months after transplantation. Eight patients developed HBV reinfection. The recurrence rate of HBV was 6. 3%. The reinfection risks were 14. 3% and 4. 0% respectively among patients with serum HBeAg positive and negative before transplantation （P 〈 0. 05 ）. Among patients with serum HBsAg positive and negative at the first day after liver transplantation, the reinfection risks were 21.1% and 3.7% respectively （P 〈 0. 05 ）. Conclusions Combination of intramuscular HBIg and Lamivudine as prophylaxis of HBV reinfection is effective. HBeAg positive before liver transplantation and HBsAg positive at the first day after transplantation are risk factors of HBV reinfection.