121例重型乙型肝炎肝移植术后乙型肝炎病毒再感染的防治

Experiences of prevention and treatment of hepatitis B virus reinfection after liver transplantation for severe hepatitis B: report of 121 cases

目的探讨重型乙型肝炎肝移植术后乙型肝炎病毒(hepatitis B virus,HBV)再感染的防治。方法回顾性分析了121例重型乙型肝炎患者,移植前后给予抗病毒药物预防乙型肝炎病毒再感染,拉米夫定+乙肝免疫球蛋白(HBIg)114例,阿德福韦+拉米夫定+HBIg4例,恩替卡韦+HBIg3例,观察临床症状、血清HBsAg、血清HBeAg、血清HBVDNA及肝活检免疫组织化学检测等指标。结果用拉米夫定+HBIg预防的114例患者中,有4例出现再感染,表现为血清HBsAg阳性,肝活检免疫组织化学检测有HBsAg表达,其中3例经治疗后HBsAg转阴。用阿德福韦+拉米夫定+HBIg或恩替卡韦+HBIg预防的7例中,血清学和肝活检免疫组织化学检测均无HBsAg表达。结论拉米夫定+HBIg﹑拉米夫定+阿德福韦+HBIg或恩替卡韦+HBIg的联合应用以及合理使用免疫抑制剂可以有效预防重型乙型肝炎患者移植术后乙型肝炎病毒的再感染。

Objective To explore and discuss the prevention and treatment of hepatitis B virus reinfection after liver transplantation for severe hepatitis B. Methods One hundred and twenty-one cases of severe hepatitis B were given antiviral drugs pre and post transplantation to prevent hepatitis B virus reinfection. Lamivudine＋ HBIg was administered in 114 cases, lamivudine＋adefovir＋HBIg in 4 cases and entecavir＋HBIg in 3 cases. The serum HBsAg, serum HBeAg, HBV DNA, liver biopsy, immunohistochemistry and clinical symptoms were observed. Results Four of 114 cases given lamivudine＋HBIg developed reinfection, in whom serum HBsAg was positive and liver biopsy immunohistochemistry showed HBsAg phenotype. The serum HBV DNA was positive in one of them. The serum HBsAg phenotype of three cases was negative after therapy. Four cases given adefovir and 3 cases given entecavir did not developed reinfection with HBV. Conclusions Lamivudine＋HBIg, lamivudine＋adefovir＋HBIg, entecavir＋HBIg and proper use of immunosuppressant can effectively prevent hepatitis B virus reinfection after liver transplantation for severe hepatitis B.