抗病毒治疗对乙型肝炎病毒感染者肾移植术后临床转归的影响

The antiviral treatment impacts on clinical outcomes of renal transplantation recipients with hepatitis B virus infection

目的探讨乙型肝炎病毒感染者肾移植术后临床转归及治疗对策。方法将术前乙肝病毒标志物阳性（HBsAg阳性、HBeAg阳性或HBeAb阳性、HBVDNA阳性或阴性）的32例肾移植术后患者分为抗病毒治疗组和无抗病毒治疗组两组。观察两组（术前1周至术后9年）的肝功能（ALT、AST、TBIL、PT）变化、病毒复制（HBVDNA）及存活情况。结果抗病毒治疗组23例患者肝功能损害复常率为82．60％，存活率为82．60％，HBVDNA（PCR法）下降（≥2log10）或保持低复制率为86．95％；未抗病毒组9例患者肝功能损害复常率为22．22％，存活率为11．11％，HBVDNA（PCR法）下降（≥2log10）或保持低复制率为11．11％。抗病毒组肝功能复常率、存活率及HBVDNA下降或保持低复制率高于无抗病毒组，两组比较差异有统计学意义（P〈0．05）。19例拉米夫定治疗患者6例出现病毒学反弹31．58％，1例加用阿德福韦酯，2例换用恩替卡韦后好转，其余3例肝功能衰竭死亡。结论持续有效的抗病毒治疗可以有效控制乙肝病毒复制，促进肝功能恢复，减少肝衰竭发生，提高乙肝病毒感染者肾移植术后患者存活率。在治疗过程中出现病毒学反弹应及时换用或加用有效药物减少肝衰竭发生。

Objective To investigate the clinic outcomes and the efficacy of antiviral treatment in renal transplantation recipients with hepatitis B viral serum markers positive. Methods 32 renal transplantation recipients with hepatitis B viral serum markers positive were enrolled. 23 patients in antiviral treatment group have received the lamivadine（19 cases）, enticavir（2 cases） and adefovir（1 case）. Another 9 patients have not received the antiviral treatment and were as the control group. Results The biochemical response rate in antiviral treatment group and control group is 82.60% and 22.22%, respectively. 19 of 23（82.60%） patients in treatment group survived and 1 of 9 （ 11.11% ） patients in control group survived （ P 〈 0. 05）. 20 of 23 （86.95 % ） patients in treatment group have the reduction of HBV DNA more than 2 log copies/ml or maintain less than 5 log copies/ml, while 1 of 9 （ 11.11% ） patients in control group has the HBV DNA maintain less than 5 log copies/ml （ P 〈 0.05）. The virology rebound was observed in 6 of 19（31.58%） patients with lamivudine treatment. 2 of them shift to enticavir treatment and 1 of them add adefovir treatment. The three patients survived. Other 3 patients die of liver function failure. Conclusion The antiviral could improve the survival in renal transplantation recipients with hepatitis B viral serum markers positive. When the virology rebound occurs, the add-on with adefovir or the shift to enticavir could be a rescue treatment.