异基因造血干细胞移植后乙型病毒性肝炎防治新进展

Advance in prevention and treatment of hepatitis B after allogeneic hematopoietic stem cell transplantation

异基因造血干细胞移植(allo-HSCT)是治愈恶性血液病的有效手段,但移植患者因接受感染乙型肝炎病毒(HBV)的移植物、免疫功能严重受损等原因,术后并发乙型病毒性肝炎的风险增加。恩替卡韦和替诺福韦是目前公认用于预防allo-HSCT后乙型病毒性肝炎的有效药物,显著减少移植后患者的肝损伤。移植后患者的免疫重建时间长且重建规律存在异质性,导致术后监测和预防性抗HBV治疗的最佳持续时间尚未能明确。本文对allo-HSCT后HBV再激活的发生机制、乙型病毒性肝炎的特点及防治的最新研究进展进行综述。

Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an effective therapy to cure hematological malignancies.However,recipient’s risk of developing hepatitis B after transplantation is increasing due to receiving graft infected with hepatitis B virus(HBV)and seriously impaired immune function.Entecavir and tenofovir are currently recognized as effective drugs for the prevention and treatment of hepatitis B in recipient,significantly reducing liver damage after transplantation.The immune reconstitution of recipient takes a long time and has hete-rogeneity,so the best duration of post-operative monitoring and antiviral prophylaxis is not clear.This article reviews the mechanism of hepatitis B virus reactivation,the characteristics of hepatitis B and the recent advance in prevention and treatment of hepatitis B after allo-HSCT.