供受者乙型肝炎病毒感染对造血干细胞移植后受者临床影响的研究

The influence of hepatitis B virus infection on patients undergoing allogeneic hematopoietic stem cell transplantation

目的 分析感染乙型肝炎病毒（HBV）的供、受者异基因造血干细胞移植（allo-HSCT）后,受者HBV血清学标志变化及对临床结果 的影响.方法 对2002年9月至2008年11月79例alloHSCT治疗前供、受者HBV感染患者的临床资料进行回顾性分析.结果 ①移植前供、受者HBV感染对受者预后无明显影响.②HBsAg阳性组患者20例,13例（65.0%）出现HBV激活,时间为移植后1（0.5～10）个月,9例（45.0%）并发乙肝相关肝炎.③HBsAg阴性组患者35例,4例（11.4%）移植后HBsAg转为阳性,即出现乙肝血清学转换.其中1例伴随严重慢性移植物抗宿主病（cGVHD）.④HBsAg阳性组患者移植后出现HBV激活及移植后100 d内肝功能损害的比例均明显高于HBsAg阴性组患者（P〈0.05）.⑤2例（10.0%）HBsAg阳性患者在移植后清除体内HBV,其供者乙肝血清学标志均为HBsAb阳性.结论 供、受者HBV感染不是allo-HSCT的禁忌证 HBsAg阳性是移植后发生HBV激活的高危因素,对于这类患者应进行规范性拉米夫定预防性治疗 HBcAb/HBeAb阳性患者移植后可能出现乙肝血清学转换,在免疫抑制剂减量过程中应密切监测其乙肝血清学标志变化 alloHSCT可以通过过继免疫治疗清除患者体内HBV.

Objective To investigate the prognosis and hepatitis B serologic marker changes in patients with HBV infection or with HBV infected donors after allogenic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical outcomes of 79 patients receiving allo-HSCT, including 55 with HBV infection and 24 from HBV infected donors were analyzed retrospectively. Results ① HBV infection did not interfere with the clinical outcome of allo-HSCT. ②In 20 HBsAg＋ patients, 13（65.0%） developed HBV reactivation between 0.5 and 10 months after transplantation, 9（45.0% ） developed HBV-related hepatitis. ③ For the 35 HBsAg- and HBcAb/HBeAb positive patients, 4 （11.4% ） occurred HBV seroconversion, 1 of the 4 complicated with severe chronic graft-versus-host disease （cGVHD）. ④ There was a significant difference in HBV reactivation rate between the HBsAg＋ and HBsAg-groups（P〈0.01）. The incidence of hepatitis occurred within 100 days after HSCT was high in HBsAg＋ patients（P〈0.05）. ⑤ Clearance of HBsAg was observed in 2 HBsAg＋ patients, both of whom received graft from HBsAb positive donors. Conclusions Donors or recipients infected with HBV is not considered an absolute contraindication for HSCT, but HBsAg pos-itivity is a high risk factor for HBV reactivation and prophylactic lamivudine treatment may be helpful. For patients with HBcAb/HBeAb positivity, seroconversion can be observed, especially after immunosuppressant withdrawal. Adoptive immunity is effective in clearing HBV in these patients.