乙肝病毒携带者拉米夫定联合乙肝免疫球蛋白预防治疗的临床观察

The combination of lamivudine and hepatitis B immune globulin in the prophylatic treatment of HBsAg positive renal transplant receipts

目的:探讨拉米夫定(LAM)联合乙肝免疫球蛋白(HBIG)预防乙肝病毒(HBV)携带者肾移植术后乙肝活动的疗效。方法:2003年7月至2007年11月共24例HBsAg阳性患者入组。术后随机分为LAM组(11例)和LAM+HBIG组(13例)。观察肾移植术后两组受者HBV复制、ALT变化,分析其与急性排斥反应发生及与预后的关系。结果:随访期间LAM组受者乙肝复发率为18.2%(2/11),2例死于乙肝复发所致急性肝功能衰竭,2例移植肾丢失,人存活率为81.8%(9/11),移植肾存活率为63.6%(7/11);LAM+HBIG组受者无乙肝复发,随访期间无死亡及移植肾无丢失者,人、肾存活率均为100%。结论:LAM联合HBIG预防性治疗乙肝活动的肾移植受者,能够减少术后的乙肝复发率,进一步提高这类受者的人/肾存活率。

Objective： To observe the effect of preventing the recurrence of hepatitis B with the combination of lamifudine and hepatitis B immune globulin in the /tBsAg positive renal transplant receipts. Methodology： Twenty-four HBsAg positive renal transplant receipts with normal liver function, HBeAg negative and normal HBV-DNA were selected in this study. They were 20 male and 4 female with average age of （ 39. 6 ± 9. 86） years old, and divided into two groups ： received lamivudine （ LAM group, n = 11 ）, and received combination of lamivudine and hepatitis B immune globulin （LAM ＋ HBIG group n = 13 ）. All of them were received the triple immunosuppressive drugs of taerolimus, mycophenlate mofetil and prednisone, and followed up at least for over two years. The tests of HBsAg, HBV-DNA copies, the live function were performed during the follow-up time. The recurrence rate of hepatitis B, the rate of acute rejection, and the receipts and allograft survival were compared between two groups. Results ： In LAM group, the mean of follow up time was （ 54. 4± 24. 0） months. Two cases died of acute liver failure and two lost their renal allograft function. The recurrence rate was 18.2%. The receipts survival were 81.8% （9/11）, and the allograft survival was 63.6% （7/11）. In the LAM ＋ HBIG group, the mean of follow up time was （37.2 ± 8. 76） months. None had acute liver failure and died, and also none lost their renal allograft function. The receipt and allograft survival were both 100%. Conclusion：The combination of lamivudine and hepatitis B immune globulin in the HBsAg positive renal transplant receipt can decreased the recurrence of hepatitis B and improve the renal allograft and receipt survival. The conclusion should be made by large scale clinical trials in the future.