恩替卡韦联合短期应用HBIG预防肝移植术后乙肝复发

Entecavir combined with short-term use of hepatitis B immune globulin in preventing hepatitis B recurrence after liver transplantation

目的探讨恩替卡韦联合短期应用乙肝免疫球蛋白（HBIG）在预防肝移植术后乙肝复发中的效果。方法本前瞻性研究对象为2013年12月至2015年10月在中山大学附属第三医院行肝移植术的35例患者。所有患者均签署知情同意书，符合医学伦理学规定。根据肝移植术后抗病毒方案将患者分为研究组和对照组。其中研究组15例，男13例，女2例；年龄19～51岁，中位年龄43岁；术后采用恩替卡韦联合围手术期短期静脉注射大剂量HBIG抗病毒治疗。对照组20例，均为男性；年龄29～71岁，中位年龄49岁；术后采用恩替卡韦联合长期肌肉注射小剂量HBIG抗病毒治疗。术后对患者进行随访，观察两组患者的抗-HBs滴度、HBsAg滴度、HBV-DNA水平以及乙肝复发率。结果研究组患者抗．HBs滴度随着术后时间的推移而逐渐降低，至术后6个月时抗。HBs滴度的中位数为2．6（0～351．0）IU／ml，至术后12个月时抗．HBs滴度为1．5（0～8．2）IU／ml。随访期间两组患者各时间点检测HBsAg均〈1IU／ml，HBV-DNA均〈100IU／ml。两组患者均未发现乙肝复发。结论恩替卡韦联合围手术期短期应用HBIG预防肝移植术后乙肝复发可取得良好的近期效果。

Objective To investigate the effects of entecavir combined with short-term use of hepatitis B immune globulin （HBIG） in preventing hepatitis B recurrence after liver transplantation （LT）. Methods Thirty-five patients who underwent LT in the Third Affiliated Hospital of Sun Yat-sen University between December 2013 and October 2015 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the anti-virus regime after LT, the patients were divided into the study group （n=15） and control group （n=20）. In the study group, 13 were males and 2 were females, aged 19-51 years old with a median age of 43 years old. They received antiviral therapy of entecavir after LT combined with short-term intravenous administration of high-dose HBIG during the perioperative period. In the control group, all patients were males, aged 29-71 years old with a median age of 49 years old. They received antiviral therapy of entecavir combined with long-term intramuscular injection of low-dose HBIG after LT. During the postoperative follow-up, anti-HBs titer, HBsAg titer, hepatitis B virus-deoxyribonucleic acid （HBV-DNA） level and the recurrence rate of hepatitis B of two groups were observed. Results In the study group, anti-HBs titer gradually decreased as time went on after surgery, and the median anti-HBs titer was respectively 2.6（0-351.0） and 1.5（0-8.2） IU/ml at 6 and 12 months. At every time points during follow-up, HBsAg titer was all 〈1 IU/ml and HBV-DNA level was all 〈100 IU/ml in two groups. No hepatitis B recurrence was observed in two group. Conclusion Entecavir combined with short-term use of HBIG during perioperative period can receive good recent effects in preventing hepatitis B recurrence after LT.