乙型肝炎免疫球蛋白个体化剂量协同核苷类抗病毒药降低肝移植乙型肝炎复发率

Reduction of hepatitis B recurrence after liver transplantation using hepatitis B immunoglobulin combined with nucleoside analogs

背景:如何有效地防治肝移植后的乙型肝炎复发目前尚无统一的治疗方案。目的:评价阿德福韦酯、恩替卡韦联合不同剂量乙型肝炎免疫球蛋白等方案对肝移植后乙型肝炎复发的防治效果。方法:回顾性分析117例乙型肝炎相关性肝硬化行肝移植患者的临床资料,采用3种乙型肝炎复发防治方案,按时间先后分为5组:A组为阿德福韦酯+小剂量抗乙型肝炎免疫球蛋白的短期方案组,B组为阿德福韦酯+大剂量乙型肝炎免疫球蛋白的中长期方案组,B+组为A组中疗效较差改用方案B组,C组为恩替卡韦+适量乙型肝炎免疫球蛋白的个体化治疗方案组,C+组为A、B、B+组中疗效较差改用方案C组。比较各组患者肝移植后乙型肝炎病毒累积有效抑制率及强效抑制率的差异,随访≥2年。结果与结论:C组、C+组、B组、B+组的乙型肝炎累积有效抑制率及强效抑制率均显著高于A组(P<0.05),C组、C+组疗效分别优于B组及B+组(P<0.05)。提示肝移植后乙型肝炎复发的防治是一个长期乃至终生的过程,适量乙型肝炎免疫球蛋白加抗病毒药的个体化方案更有利于防治乙型肝炎复发。

BACKGROUND：There is not a united method for preventing and treating hepatitis B recurrence after liver transplantation.OBJECTIVE：To investigate the control plans of hepatitis B recurrence after liver transplantation.METHODS：Totally 117 liver transplantation recipients with liver cirrhosis after chronic hepatitis B were analyzed retrospectively.Using three therapeutic scheme,the patients were divided into 5 groups according to the received treatment time：adefovir dipivoxil plus low dose hepatitis B immunoglobulin（HBIG） short-term group（group A）,adefovir dipivoxil plus high dose HBIG mid-long-term group（group B,group B＋）,entecavir plus suitable dose HBIG individual therapy group（group C,group C＋）.Then the cumulating effective inhibition rate and powerful inhibition rate of HBV were observed.All of patients were followed-up 2 years at least.RESULTS AND CONCLUSION：The cumulating effective inhibition rate and powerful inhibition rate of HBV in group B,B＋,C and C＋ were much higher than that in group A（P 0.05）.The therapeutic effect of hepatitis B in groups C,C＋ were better than that in group B,B＋ respectively（P 0.05）.The results demonstrated that prevention of hepatitis B recurrence after liver transplantation is a long-term,even for a life time process,suitable dose of HBIG combined with antiviral drug is benefit for the prevention and cure of hepatitis B recurrence.