替诺福韦单一用药预防肝移植术后乙肝复发的疗效分析

Efficacy analysis of tenofovir monotherapy in the prevention of hepatitis B virus recurrence of patients after liver transplantation

目的探讨乙型肝炎病毒(hepatitis B virus,HBV)相关肝移植(liver transplantation,LT)后停用乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)单用替诺福韦(tenofovir disoproxil fumarate,TDF)预防HBV复发的有效性、安全性及经济性。方法选取我院HBV相关LT患者,将患者分为TDF单药组和恩替卡韦(entecavir,ETV)联合HBIG用药组,收集患者临床及实验室数据并比较两种用药方案的效果、不良反应及用药花费。结果截止到2019年6月30日,本研究终纳入单药组10例和联用组28例,分别平均随访13.50个月和13.03个月,单药组1例(10.00%)和联用组2例(7.14%)出现乙肝表面抗原(hepatitis B surface antigen,HBsAg)阳性复发,所有患者术后乙肝DNA(hepatitis B virus DNA,HBV-DNA)始终为阴性,联用组1例(3.57%)死亡,单药组费用明显低于联用组(490元/月比1952.55元/月,P<0.01)。结论与ETV联合HBIG相比,LT后TDF单药预防HBV复发,具有良好的有效性、安全性和经济性。

Objective To evaluate the efficacy,safety and economy of tenofovir(TDF)monotherapy in the prevention of hepatitis B Virus(HBV)recurrence after hepatitis B immunoglobulin(HBIG)withdrawal in liver transplantation(LT)recipients.Methods HBV-related LT patients were selected in our hospital.They were divided into the TDF monotherapy group and entecavir(ETV)combined with HBIG group.We collected clinical and laboratory data of patients and compared the preventive effects,adverse effects and drug costs of the two drug regimens.Results Until June 30th,2019,ten patients in the monotherapy group and 28 patients in the combined group were included.Mean follow-up time of the two groups were 13.50 and 13.03 months,respectively.One patients in the monotherapy group(10.00%)and two patients in the combined group(7.14%)showed recurrence of Hepatitis B surface antigen(HBsAg)positive.All patients had consistently negative hepatitis B virus DNA(HBV-DNA)after LT.One patient(3.57%)in the combined group died.The cost of monotherapy group was significantly lower than that of the combined group(490 yuan/month vs.1952.55 yuan/month,P<0.01).Conclusion Compared with ETV and HBIG,it is effective,safe and economical for patients to discontinue HBIG and use TDF monotherapy in the prevention of HBV recurrence after LT.