肝移植受者术后早期发生获得性丙型肝炎病毒感染三例

The diagnosis and therapy of early De novo hepatitis C virus infection after liver transplantation

目的分析肝移植术后早期发生获得性丙型肝炎病毒（HCV）感染的临床特点，总结诊断和治疗经验。方法回顾性分析3例肝移植术后早期发生获得性HCV感染受者的临床资料，评价HCV-RNA检测方法对肝移植术后发生获得性HCV感染的诊断价值，观察丙氨酸转氨酶（ALT）与他克莫司（FK506）的血药浓度、用药剂量及浓度／剂量比值的变化特点。结果与抗-HCV及移植肝活组织HCV抗原检测相比，HCV-RNA检测可更早确诊HCV感染。3例术后早期发生获得性HCV感染的受者均出现FK506血药浓度异常升高，并伴随出现ALT水平及FK506血药浓度／剂量比值的异常升高。结论HCV-RNA检测是确诊肝移植术后早期发生获得性HCV感染的最佳方法；确诊后应调整FK506的用药剂量，使其血药浓度维持在治疗窗内，并积极保护移植肝功能。

Objective To analyze the clinical features of early De novo hepatitis C virus infection after liver transplantation and summarize the experience of diagnosis and therapy. Methods Three cases of early De novo hepatitis C infection after liver transplantation were retrospectively. The diagnos tic value of HCV-RNA test was estimated, the changes in glutamate-pyruvate transaminase （ALT）, tacrolimus （FK506） concentration level, dosage and level/dosage ratio were observed. Results Blood HCV-RNA test confirmed early De novo hepatitis C infection after liver transplantation earlier than blood HCV-Ab test and liver biopsy HCV-Ag test （NS3 staining）. FKS06 concentration in all cases was increased significantly after operation, at the same time, ALT level and the FK506 level/dose ratio rised abnormally. Conclusions HCV-RNA test is the best method to diagnose early De novo hepatitis C infection after liver transplantation. FK506 dosage should be adjusted after confirming diagnosis and protection of liver function is needed.