肝移植患者乙肝免疫球蛋白血药浓度回顾性分析

Retrospective Analysis of Blood Concentration Monitoring for Hepatitis B Immunoglobulin in Liver Transplantation Patients

目的:回顾性分析肝移植患者术后不同时间点乙肝免疫球蛋白(HBIG)用量、滴度及乙肝表面抗原(HBsAg)阴转率的关系,为临床用药提供参考。方法:对因乙肝相关性终末期肝病接受肝移植手术患者,根据术前乙肝病毒核酸定量(HBV-DNA)及乙肝病毒e抗原(HBeAg)水平分为高复制组(术前HBV-DNA(+)和(或)HBeAg(+))和低复制组(术前HBV-DNA(-)且HBeAg(-)),比较术后1、7、14、21d及4、8、12、24周时,组间HBIG用量、滴度及HBsAg阴转率之间的关系及其组间差异。结果:30例患者在HBIG累积用量为6000IU时,HBIG滴度>500IU·L-1且术后7dHBsAg全部转阴;高复制组HBIG累积用量14000IU时患者HBsAg全部转阴,而低复制组HBIG累积用量为12000IU时患者HBsAg全部转阴,2组HBsAg阴转率差异有统计学意义(P<0.05)。高复制组患者HBIG滴度降低速度快于低复制组,差异有统计学意义(P<0.05)。结论:术后HBIG用量、滴度及HBsAg阴转率与术前HBV-DNA和HBeAg状态有关。对于术前高复制患者可考虑增大HBIG用量,并在术后严密监测HBIG滴度来调整临床用药方案。

OBJECTIVE： To retrospectively analyze the relationship between the doses, titers of hepatitis B immune globulin （HBIG） and the negative-conversion rates of serum HBsAg in liver transplantation patients at different time points postoperatively. METHODS： Patients submitted to liver transplantation for HBV related end-stage liver diseases were divided into high recurrence group （HBV-DNA（＋） and or HBeAg（＋） before operation） and low recurrence group （HBV-DNA（ - ） and HBeAg（ - ） before op- eration） based on preoperative levels of HBV-DNA and HBeAg. The difference of the dose, titers of HBIG and the negative-conver- sion rates of HBsAg were compared between 2 groups in 1 d, 7 d, 14 d, 21 d, 4 w, 8 w, 12 w and 24 w postoperatively. RE- SULTS： When cumulative dose of HBIG was 6 000 IU, the titer of HBIG was higher than 500 IU·L-1 and the 100% HBsAg nega- tive-conversion rate was obtained in 7 d after operation. All patients were HBsAg-negative when the dose of HBIG was 14 000 IU in high recurrence group. In low recurrence group, when the dose of HBIG was 12 000 IU, all patients were HBsAg-negative. There was statistical significance in the difference of HBsAg negative-conversion rate between 2 groups （P〈0.05）. The decrease ve- locity of HBIG titers in high recurrence group was higher than in low recurrence group, there was statistical significance （P〈0.05）. CONCLUSION： The titer and dose of HBIG and negative-conversion rate of HBsAg are correlated with preoperative situa- tion of HBV-DNA and HBeAg. Patients in high recurrence group should receive a higher level of HBIG and adjust clinical regimen by closely monitoring the titer of HBIG after operation.