异基因造血干细胞移植中供受体乙肝病毒感染的意义

The significance of hepatitis B virus infected patients or donors in allogeneic hematopoietic stem cell transplantation

目的分析白血病患者移植前供、受者感染乙型肝炎病毒（HBV）对异基因造血干细胞移植（allo-HSCT）临床结果的影响。方法对该院1996年5月至2005年2月间进行的31例合并HBV感染的HSCT患者临床资料进行回顾性分析。结果31例受者均达到造血干细胞植活，乙型肝炎指标供者阳性、受者阴性8例。其中1例26个月死于肝硬化，2例在免疫抑制剂停用后。发展为慢性活动性肝炎；乙型肝炎指标供者阴性、受者阳性20例，其中2例乙型肝炎指标转阴。5例获得HBsAb（＋），4例移植后HBcAb转阴及HBeAb转阴，仅HBsAb（＋），1例转为“HBsAg（＋）、HBeAg（＋）、HBcAb（＋）”；乙型肝炎指标供者、受者均阳性3例，1例患者并发肝静脉闭塞病（VOD），1例获得一过性HbsAg（＋）。1例获得HbsAb（＋）。结论HBV感染对千细胞植活时间无明显影响；供、受者感染乙肝病毒不是HSCT的绝对禁忌证；HBsAg（＋）及HBV滴度是影响移植后乙型肝炎复发的重要因素；HBsAg（＋）的患者可作为HbsAb（＋）受者的供者，但对HbsAb（-）受者则应慎重；拉米夫定及乙肝免疫球蛋白联合应用较乙肝疫苗单独使用更能有效地控制HBsAg（＋）的供受者在移植后的乙型肝炎疾病的进展；HSCT有可能通过过继免疫治疗乙型肝炎。

Objective To investigate the impact of hepatitis B virus infected recipients or donors on the outcome of allogeneic hematopoietic stem cell transplangtation （allo-HSCT）. Methods We analyzed retrospectively the outcome of 31 patients who and whose donors were infected with hepatitis prior to transplantation between July 1996 and February 2005 in our hospital. Results All 31 patients achieved full engraftment; eight donors with HBV markers positive while recipients were negative, one of them died of liver cirrhosis in 26 months after transplantation,Two of them developed chronic active hepatitis B; twenty recipients with HBV markers positive while donors were negative, viral markers converted to negative in two patients, five patients acquired HBsAg positive. HBsAb and HBeAg disappeared only remained HBsAb positive in four patients, one patients turned to be ＂HBsAg＋, HBeAe＋, HBcAb＋＂; 3 patients who and whose donors were all HBV marks postive, One of them died of veno-occlusive disease （VOD）,One acquired temporality HBsAg＋, one acquired HBsAb＋ post transplantation. Conclusion HBV infection do not interfered with the engraftment of hematopoietic stem cell; donors and recipients infected with hepatitis B are not contraindication of HSCT; HBsAg positive and high hepatitis B virus（HBV） DNA viral load are the most important risk factors for HBV reactivation in patients post transplantation; patients with HBsAb positive can accept the graft from HBsAg positive donors, but we should be more cautious to HBsAb negative recipients; Prophylactic use of hepatitis B immunoglobulin（HBIG） combined with lamivudine can do much better in preventing recurrence of hepatitis B virus in recipients after HSCT than use of hepatitis B virus vaccination alone; HSCT may clear hepatitis B surface antigen through adoptive immunity transfer.