恩替卡韦联合乙肝免疫球蛋白预防肝移植术后乙肝再感染

Intramuscular hepatitis B immunoglobulin combined with entecavir for long-term prophylaxis of hepatitis B re-infection after liver transplantation

目的:评价恩替卡韦联合乙肝免疫球蛋白(HBIG)预防原位肝移植(OLT)术后HBV再感染的效果,并探讨术前存在YMDD患者的预防策略.方法:回顾性分析2003-05/2008-01行同种异体原位肝移植术患者,比较长期使用与拉米夫定+肌注型HBIG预防HBV再感染的效果;并观察术前出现YMDD患者应用恩替卡韦+肌注型HBIG的疗效;两组患者观察截止2008-10,对HBV DNA定量水平、乙肝两对半、HBV再感染率进行统计学分析.结果:恩替卡韦组40例患者,随访时间19.5±9.4mo,未发现HBV再感染;拉米夫定组共84例患者,随访时间18.1±6.4mo,其中10例出现了HBV再感染,再感染率为11.9%,两组差异有统计学意义.6例术前出现YMDD患者应用恩替卡韦+肌注型HBIG预防,无术后乙肝再感染.结论:恩替卡韦联合HBIG与拉米夫定联合HBIG相比,有效地降低了肝移植术后HBV再感染率,对术前存在YMDD变异的的患者有效.

AIM： To evaluate BIG on HBV recurrence after orthotopic liver transplantation （OLT）, and to investigate prevention strategies for liver transplantation with YMDD.METHODS： One hundred and twenty four cases who underwent orthotopic liver transplanta- tion and fulfilled the enrollment criteria, were retrospectively analyzed. HBV reinfection was analyzed and compared between long-term intramuscular hepatitis B virus immunoglobulin ＆ entecavir group and intramuscular hepatitis B virus ＆ immunoglobulin and Lamivudine group. The effect of the prophylaxis for HBV reinfection in patients with YMDD mutants was investigated. HBV markers in serum, HBV DNA and the ratio of HBV reinfection were analyzed.RESULTS： Entecavir group with a followup period of 19.5 ＋ 9.4 mo, showed no HBV reinfection. However, 10 patients had been traced for 18.1 ± 6.4 mo in lamivudine group. The rate of HBV reinfection in entecavir group was significantly lower than lamivudine group （0% vs 11.9%, P 〈 0.05）. The patients with YMDD mu- tants before transplantation in Entecavir group had been traced no postoperative HBV reinfection.CONCLUSION： Entecavir and intramuscular HBIG as the prophylaxis of HBV reinfection is more effective than the lamivudine and intramuscular HBIG, especially for patients with preoperative YMDD mutants.