HBcAb阳性供肝中cccDNA与肝移植受者术后乙型肝炎病毒复发的相关性

The cccDNA in HBcAb positive donor may be one of the risk factors in HBV recurrence of hepatitis B- related liver transplantation patients

目的检测乙型肝炎病毒核心抗体（HBcAb）阳性供肝组织内乙型肝炎病毒（HBV）cccDNA，结合肝移植术后HBV复发率，探讨HBcAb阳性供肝中cccDNA与术后HBV复发的相关性。方法回顾性研究2007年1月至2010年1月1200余例因乙型肝炎相关性疾病接受肝移植的受者资料，共筛选出受者85例。根据供肝HBV感染情况，将受者分为3组：（1）研究组：40例，供肝HBcAb阳性，但HBv表面抗原（H＆Ag）阴性；（2）对照组：15例，供肝HBsAg阳性；（3）正常组：30例，供肝无HBV感染。应用荧光定量聚合酶链反应法检测供肝组织内的HBVcccDNA。定期检测受者HBV血清学及HBVDNA，如有HBsAg阳性或HBVDNA阳性者取移植肝穿刺活检确认是否复发。结果研究组、对照组及正常组分别有分别有12例、11例和0例HBVcccDNA呈阳性，其阳性率分别为30％（12／40）、73．3％（11／15）、0。研究组、对照组及正常组术后HBV的复发率分别为10％（4／40）、80％（12／15）和3．3％（1／30）。研究组中cccDNA阳性与cccDNA阴性供肝移植术后受者的HBV复发率分别为7．5％（3／40）和2．5％（1／40），二者比较，差异有统计学意义。结论HBcAb阳性供肝中cccDNA阳性可能是肝移植术后受者HBV复发的危险因素之一。肝移植术前应对HBcAb阳性供肝进行HBVcccDNA筛选，能够减少术后HBV复发率，从而扩大供肝来源。

Objective To indentify the relationship between hepatitis B virus covalently closed circular DNA （HBV cccDNA） and postoperative recurrence of HBV in HBcAb positive liver donors by detecting HBV cccDNA in liver from HBcAb positive liver donors. Method Eighty-five of 1200 patients underwent liver transplantation for hepatitis B-related end-stage liver disease in our hospital from January 2007 to January 2010 were retrospectively analyzed. According to the situation of HBV infection in donor liver, the recipients were divided into 3 groups： （1） the experimental group （livers positive for HBcAb, and negative for HBsAg, n = 40）, （2） control group （livers positive for HBsAg, n = 15）, and （3） normal group （donor livers without HBV infection, n = 30）. HBV cccDNA of donors was detected by fluorescence quantitative PCR. Serum HBV and HBV DNA were regularly tested, and biopsy was done in those positive for HBsAg or HBV DNA to confirm HBV recurrence. The relationship between HBV cccDNA and postoperative recurrence of HBV in HBcAb positive liver donors was analyzed. Result The positive rate of cccDNA was 30% in experimental group （12,40）, 73.3% in control group （11/50）, and 0 （normal group）. The rate of HBV recurrence in experimental, control and normal groups was 10% （4/40）, 80% （12/15） and 3.3%（1/30） respectively. The rate of HBV recurrence in the experimental group of cccDNA （ ＋ ） and cccDNA （ - ） was 7. 5% （3/40）, and 2. 5% （1/40）. Conclusion The cccDNA in HBcAb positive donors may be one of the risk factors in HBV recurrence of hepatitis B-related liver transplantation patients. The screening of HBV cccDNA in the donor livers positive for HBcAb before liver transplantation is recommended to reduce the positive HBV recurrence and expand the pool of liver donors for patients with HBV-related liver disease.