肝移植后乙型肝炎复发核苷类抗乙肝药物联合小剂量乙肝免疫球蛋白可能防治吗?

Hepatitis B virus recurrence after liver transplantation:Prevention and cure efficacy of nucleoside anti-hepatitis B medicine combined with low-dose anti-hepatitis B immunoglobulin

背景:近年来国内外均报道,抗乙型肝炎免疫球蛋白和拉米夫定在预防乙型肝炎、肝硬化肝移植后乙型肝炎的复发中取得了良好效果,但各大中心对于抗乙型肝炎免疫球蛋白使用剂量的报道不尽相同。目的:拟验证和探讨核苷类抗乙肝药物联合小剂量乙肝免疫球蛋白预防肝移植后乙型肝炎病毒复发的效果。方法:回顾性分析2006-05/2009-02昆明市第一人民医院暨昆明医学院附属甘美医院肝移植中心因乙型肝炎相关性肝病行肝移植患者59例,移植前诊断为乙型肝炎后肝硬化失代偿期50例,其中乙型肝炎病毒DNA阳性15例。移植前5例给予拉米夫定治疗,1例给予阿德福韦酯治疗,1例给予恩替卡韦片治疗,治疗时间为2周～1年。移植后所有患者术后第1天开始肌注200U/d的乙肝免疫球蛋白,1个月后根据患者的乙肝两对半的滴度情况进行调整,55例患者同时口服拉米夫定,3例服用阿德福韦酯,1例服用恩替卡韦。结果与结论:2例患者移植后出现乙型肝炎病毒再感染,未检测是否为YMDD变异毒株感染,移植后1年和1年以上乙型肝炎病毒再感染率均为2%。移植前血清乙型肝炎病毒DNA阴性者移植后乙型肝炎病毒再感染率为2%,乙型肝炎病毒DNA阳性者移植后乙型肝炎病毒再感染率为7%。提示因乙型肝炎相关性肝病而行肝移植患者,移植后服用核苷类抗乙肝药物,同时联合200U小剂量乙型肝炎免疫球蛋白可以很好地预防肝移植后乙型肝炎的复发。

BACKGROUND：It was reported from home and abroad that the effect of nucleoside anti-hepatitis B medicine and anti-hepatitis B immunoglobulin for prevention and cure of hepatitis B virus recurrence after liver transplantation with hepatopathy correlation with hepatitis B was good for patients.But the reported dosage of anti-hepatitis B immunoglobulin in and after liver transplantation was different.OBJECTIVE：To verify and investigate the effect of nucleoside anti-hepatitis B medicine combined with anti-hepatitis B immunoglobulin on prevention and cure of hepatitis B virus recurrence after liver transplantation.METHODS：A retrospective analysis was performed on 59 patients with liver transplantation of hepatopathy correlated with hepatitis B who were selected from Liver Transplantation Center,the Ganmay Affiliated Hospital of Kunming Medical College between May 2006 and February 2009.A total of 50 out of 59 cases were diagnosed with posthepatitic cirrhosis in decompensatio stage before transplantation,including 15 cases having positive hepatitis B DNA.Before liver transplantation,5 cases accepted Lamivudine,1 case accepted Adefovir dipivoxil,and 1 case accepted Entecavir.Treatment time ranged from two weeks to one year.All the patients accepted intramascular injection of anti-hepatitis B immunoglobulin,200 U/d;which were adjusted in the light of hepatitis B surface antibody titer.A total of 55 out of 59 cases accepted Lamivudine,3 cases accepted Adefovir dipivoxil,and 1 case accepted Eetecavir after liver transplantation.RESULTS AND CONCLUSION：Two patients underwent hepatitis b virus reinfection,but HBV variants（YMDD） reinfection was not determined,one of which occurred in one year after liver transplantation with positive pre-OLT serum hepatitis b virus DNA,another after one year with negative pre-OLT serum hepatitis b virus DNA.The reinfection rate of group with negative or positive pre-OLT serum HBV DNA was 2% and 7%,respectively.It was maybe well prevention and cure of hepatitis B after liver transplantation that patients accepted nucleoside anti-hepatitis B medicine combined with low dose anti-hepatitis B immunoglobulin（200 U/d）.