乙型肝炎免疫球蛋白不同给予方式对肝移植病人血清HBsAg和HBsAb水平的影响（前瞻、随机、平行对照的开放性临床研究）

Impact of medicating ways for hepatitis B immunoglobulin on the serum tiler of HBsAg and HBsAb （prospective, randomized, parallel-controlled, open clinical trial）

目的研究肝移植术中和术后早期经不同方式给予乙肝免疫球蛋白（HBIG）对血清HBsAg水平和HBsAb水平的影响。方法入选病例随机分为三组，在联合使用拉米夫定的情况下于术中和术后6d内经不同方式给予HBIG，于术后7d内动态检测血清HBsAg和HBsAb水平的变化情况。结果术后3d内静脉组和序贯组血清HBsAg水平的日均下降速度显著快于肌注组（P〈0．05）；术后4d内静脉组和序贯组血清HBsAb水平的日均上升速度显著快于肌注组（P〈0．05），术后6d内静脉组和序贯组每个时间点的血清HBsAb水平都显著高于肌注组（P〈0．05）。结论静脉给予HBIG者血清HBsAg水平的下降速度和HBsAb水平的上升速度都显著快于肌注给药者，序贯给药简单易行且能获得与静脉给药类似的效果。

Objective To study the impact of medicating ways for hepatitis B immunoglobulin （HBIG） on the serum titer of HBsAg and HBsAb in patients with liver transplantation due to HBV-induced end stage liver disease. Methods The patients enrolled were randomized into three groups （i. v group, i. m group and sequential group）. HBIG was medicated in different ways during anhepatic phase and the postoperative six days under the combined utilization with Lamivudine. The serum titer of HBsAg and HBsAb were tested daily during the postoperative seven days. Results 1. The serum titer of HBsAg was decreased from postoperative day one in the three groups. The daily average decreasing rate of HBsAg titer in i. v group and sequential group is significantly faster than that in i. m group within the postoperative three days （P〈0. 05）. The serum HBsAg titer got down to normal on postoperative day four in i. v group and in sequential group, while it didn＇t do so until postoperative day six by adding extra HBIG on postoperative day four and day five in i. m group. The serum titer of HBsAg is significantly lower in i. v group and sequential group than that in i. m group within the postoperative five days （P%0. 05）. 2. The serum titer of HBsAb increased from the postoperative day one in the three groups. The daily average increasing rate of HBsAb titer in i. v group and sequential group is significantly faster than that in i. m group within the postoperative four days （P〈0. 05）. The serum HBsAb titer rose up to effective protecting level （≥500 IU/L） on postoperative day three in i. v group （782. 1 IU/L） and in sequential group （785. 6 IU/L）, while it didn＇t do so until postoperative day six in i. m group （637.9 IU/L） by adding extra HBIG on postoperative day four and day five. The serum titer of HBsAb is significantly higher in i. v group and sequential group than that in i. m group within the postoperative six days （P〈0. 05）. Conclusions Based on the combined utilization with lamivudine, both the decreasing rate of serum HBsAg titer and the increasing rate of serum HBsAb titer were significantly faster in patients with HBIG medicated intravenously than that of intramuscularly. The similar results to i. v group could be obtained in sequential group, which was simple and easy to be conducted.