Intramuscular hepatitis B immune globulin combined with lamivudine in prevention of hepatitis B recurrence after liver transplantation

BACKGROUND: Combined hepatitis B immune globulin (HBIg) and lamivudine in prophylaxis of the recurrence of hepatitis B after liver transplantation has significantly improved the survival of HBsAg positive patients. This study was undertaken to evaluate the outcomes of liver transplantation for patients with hepatitis B virus (HBV). METHODS: A retrospective chart analysis and a review of the organ transplant database identified 51 patients (43 men and 8 women) transplanted for benign HBV-related cirrhotic diseases between June 2002 and December 2004 who had survived more than 3 months. HBIg was administered intravenously during the first week and intramuscularly thereafter. RESULTS: At a median follow-up of 14.1 months, the overall recurrence rate in the 51 patients was 3.9% (2/51). The overall patient survival was 88.3%, and 82.4% after 1 and 2 years, respectively. A daily oral dose of 100 mg lamivudine for 2 weeks before transplantation for 10 patients enabled 57.1% (4/7) and 62.5% (5/8) of HBV-DNA and HBeAg positive patients respectively to convert to be negative. Intramuscular HBIg was well tolerated in all patients. CONCLUSION: Lamivudine combined with intramuscular HBIg can effectively prevent allograft from the recurrence of HBV after liver transplantation.

High-dose hepatitis B immunoglobulin therapy in hepatocellular carcinoma with hepatitis B virus-DNA/hepatitis B e antigen-positive patients after living donor liver transplantation

AIM: To investigate the impact of high-dose hepatitis B immunoglobulin(HBIG) on hepatocellular carcinoma(HCC) and hepatitis B virus(HBV) recurrence and overall survival after living donor liver transplantation(LDLT).METHODS: We investigated 168 patients who underwent LDLT due to HCC, and who were HBV-DNA/hepatitis B e antigen(HBe Ag)-positive, from January 2008 to December 2013. After assessing whether the patients met the Milan criteria, they were assigned to the low-dose HBIG group and high-dose HBIG group. Using the propensity score 1:1 matching method, 38 and 18 pairs were defined as adhering to and not adhering to the Milan criteria. For each pair, HCC recurrence, HBV recurrence and overall survival were analyzed by the Kaplan-Meier method and the log rank test according to the HBIG dose. RESULTS: Among those who met the Milan criteria, the 6-mo, 1-year, and 3-year HCC recurrence-free survival rates were 88.9%, 83.2%, and 83.2% in the low-dose HBIG group and 97.2%, 97.2%, and 97.2% in the high-dose HBIG group, respectively(P = 0.042).In contrast, among those who did not meet the Milan criteria, HCC recurrence did not differ according to the HBIG dose(P = 0.937). Moreover, HBV recurrence and overall survival did not differ according to the HBIG dose among those who met(P = 0.317 and 0.190, respectively) and did not meet(P = 0.350 and 0.987, respectively) the Milan criteria. CONCLUSION: High-dose HBIG therapy can reduce HCC recurrence in HBV-DNA/HBe Ag-positive patients after LDLT.

Chronic hepatitis B infection in pregnancy

There are no standard guidelines to follow when a patient with chronic hepatitis B infection becomes pregnant or desires pregnancy. Topics to consider include which patients to treat, when to start treatment, what treatment to use and when to stop treatment. Without any prophylaxis or antiviral therapy, a hepatitis B surface antigen and E antigen positive mother has up to a 90% likelihood of vertical transmission of hepatitis B virus(HBV) to child. Standard of care in the United States to prevent perinatal transmission consists of administration of hepatitis B immune globulin and HBV vaccination to the infant. The two strongest risk factors of mother to child transmission(MTCT) of HBV infection despite immunoprophylaxis are high maternal HBV viral load and high activity of viral replication. The goal is to prevent transmission of HBV at birth by decreasing viral load and/or decreasing activity of the virus. Although it is still somewhat controversial, most evidence shows that starting antivirals in the third trimester is effective in decreasing MTCT without affecting fetal development. There is a growing body of literature supporting the safety and efficacy of antiviral therapies to reduce MTCT of hepatitis B. There are no formal recommendations regarding which agent to choose. Tenofovir, lamivudine and telbivudine have all been proven efficacious in decreasing viral load at birth without known birth defects, but final decision of which antiviral medication to use will have to be determined by physician and patient. The antivirals may be discontinued immediately if patient is breastfeeding, or within first four weeks if infant is being formula fed.

Prevention of vertical transmission of hepatitis B virus infection

Hepatitis B virus(HBV)is the leading cause of chronic viral hepatitis.Annually,almost two million children younger than 5 years acquire the infection,mostly through vertical or horizontal transmission in early life.Vertical transmission of HBV is a high efficacy phenomenon ranging,in the absence of any preventive interventions,from 70%to 90%for hepatitis e antigen positive mothers and from 10%to 40%for hepatitis e antigen-negative mothers.Maternal viraemia is a preeminent risk factor for vertical transmission of HBV.Maternal screening is the first step to prevent vertical transmission of HBV.Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection.Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low-and middle-income countries where the prevalence of the infection is at the highest.

Prevention of recurrent hepatitis B infection after liver transplantation

BACKGROUND:Recurrence of hepatitis B virus(HBV) infection after liver transplantation can lead to graft loss and a reduction in long-term survival.The purpose of this review is to summarize the current therapeutic options for preventing HBV recurrence in liver transplant recipients.DATA SOURCES:Up to January 2013,studies that were published in MEDLINE and EMBASE on prevention of HBV recurrence after liver transplantation were reviewed.RESULTS:There have been remarkable advancements in the past two decades on the prevention of HBV recurrence after liver transplantation,from the discovery of hepatitis B immune globulin(HBIG) and lamivudine monotherapy to the combination therapy using HBIG and lamivudine.With the development of newer and stronger antiviral agents,the need for life-long HBIG is doubtful.With their low resistance profile,oral antiviral prophylaxis using these new agents alone is sufficient and is associated with excellent outcome.CONCLUSIONS:Restoration of host HBV immunity with adoptive immunity transfer and vaccination may represent the ultimate strategy to withdraw prophylactic treatment and to achieve a drug free regimen against HBV recurrence after liver transplantation.

Prevention and treatment of hepatitis B recurrence after liver transplantation

OBJECTIVE: To study the efficacy of liver transplantation on end-stage hepatitis B related liver diseases, and the prevention and treatment strategies of hepatitis B recurrence after the transplantation. METHODS: The efficacy of combined treatment of lamivudine and hepatitis B immune globulin (HBIG) therapy on 24 patients who had received liver transplantation was retrospectively studied. RESULTS: All the 24 patients with end-stage hepatitis B-related liver diseases treated with lamivudine alone or combined therapy of lamivudine and HBIG showed normal liver function and 21 of them lost hepatitis B virus (HBV) markers. However, the remaining 3 patients became HBsAg positive again soon after liver transplantation. CONCLUSIONS: Liver transplantation is effective for patients with end-stage hepatitis B-related liver diseases. Combined treatment of lamivudine and HBIG may prevent the recurrence of hepatitis B after the operation.

Hepatitis B virus: Where do we stand and what is the next step for eradication?

Hepatitis B(HB) virus(HBV) infection, which causes liver cirrhosis and hepatocellular carcinoma, is endemic worldwide. Hepatitis B vaccines became commercially available in the 1980 s. The World Health Organization recommended the integration of the HB vaccine into the national immunisation programs in all countries. HBV prevention strategies are classified into three groups:(1) universal vaccination alone;(2) universal vaccination with screening of pregnant women plus HB immune globulin(HBIG) at birth; and(3) selective vaccination with screening of pregnant women plus HBIG at birth. Most low-income countries have adopted universal vaccine programs without screening of pregnant women. However, HB vaccines are not widely used in low-income countries. The Global Alliance for Vaccine and Immunization was launched in 2000, and by 2012, the global coverage of a three-dose HB vaccine had increased to 79%. The next challenges are to further increase the coverage rate, close the gap between recommendations and routine practices, approach highrisk individuals, screen and treat chronically infected individuals, and prevent breakthrough infections. To eradicate HBV infections, strenuous efforts are required to overcome socioeconomic barriers to the HB vaccine; this task is expected to take several decades to complete.

Management of chronic hepatitis B before and after liver transplantation

Liver transplantation remains the only curative option for eligible patients with complications of chronic hepatitis B(CHB) infection,including severe acute hepatitis flares,decompensated cirrhosis,and hepatocellular carcinoma. In general,all patients with CHB awaiting liver transplantation should be treated with oral nucleos(t)ide analogs(NAs) with high barriers to resistance to prevent potential flares of hepatitis and reduce disease progression. After liver transplantation,lifelong antiviral therapy is also required to prevent graft hepatitis,which may lead to subsequent graft loss. Although combination therapy using NA and hepatitis B immune globulin(HBIG) has been the regimen most widely adopted for over a decade,recent studies have demonstrated that newer NAs with low rates of resistance are effective in preventing graft hepatitis even without the use of HBIG,achieving excellent long term outcome. For patients without pre-existing resistant mutations,monotherapy with a single NA has been shown to be effective. For those with resistant strains,a combination of nucleoside analog and nucleotide analog should be used. To date,clinical trials using therapeutic vaccination have shown suboptimal response,as CHB patients likely have an immune deficit against HBV epitopes. Future strategies include targeting different sites of the hepatitis B replication cycle and restoring the host immunity response to facilitate complete viral eradication.

孕晚期肌肉注射HBIG与新生儿及产后乳汁HBV-DNA含量相关性分析

目的通过对孕产妇各个时期注射高效价乙肝免疫球蛋白(HBIG)后血清及乳汁中HBV DNA含量的分析、比较,为乙肝携带者孕产妇的乙肝病毒的母婴阻断及产后母乳喂养方案提供实验依据。方法选取2012年6月至2014年6月在该院产科门诊进行产前检查HBsAg(+)的乙肝携带者孕妇140例,根据自愿、保密的原则,分为研究组和对照组,其中研究组75例于孕期28、32、36周进行肌注高效价HBIG 200U,对照组65例中的孕产妇由于各种原因在孕期未进行HBIG注射。分别于注射前、分娩前检测两组血清中HBV DNA含量、分娩后对新生儿血清及3~5d内乳汁进行HBV DNA含量检测,分析两组的差异及相关性。结果注射HBIG前研究组HBV DNA含量<500copies/mL、500^(-1)×10~6copies/mL、>1×10~6 copies/mL分别为:28例、17例、30例,产前分别为:35例、20例、20例;对照组产前2次检测为:19例、21例、25例及20例、17例、28例;在研究组与对照组中新生儿血清HBV DNA阳性分别为:1例(5.3%)及5例(7.7%);在两组乳汁中HBV DNA阳性分别为:3例(4%)和8例(12.3%)。结论乙肝携带者孕妇在孕晚期进行HBIG的注射可能影响其乙肝病毒的复制进而减少新生儿宫内感染的概率,同时降低其产后乳汁的HBV DNA的阳性率。

孕晚期使用HBIG阻断HBV宫内感染的系统评价

目的:运用循证医学理论和方法,就孕晚期使用乙肝免疫球蛋白(HBIG)阻断乙肝病毒(HBV)宫内感染的阻断效果和安全性进行系统评价。方法:采用Cochrane系统评价的方法,计算机检索PubMed(1980-2012年)、EMBASE(1980-2012年)、Cochrane图书馆(2012年第3期)、中国生物医学文献数据库(CBMdisc,1980-2012年)、中国学术期刊全文数据库(CNKI,1980-2012年)、中文科技期刊全文数据库VIP(1980-2012年),手工检索2002-2012年相关杂志。两个评价员首先独立地阅读文章标题及摘要,如符合纳入标准则阅读全文,并进行数据资料提取及质量评价。不同意见通过讨论解决或由第三方判断。从随机方法、分配隐藏、盲法、有无失访几方面,对纳入研究的方法学质量进行评价,数据采用Rev Man 4.2软件进行统计分析。结果:通过电子检索与手工检索,获得相关文献共18 631篇,经质量评估筛选后,其中5个随机对照试验(包含442例孕妇)符合纳入标准,对其进行了系统评价。经分析,这5个纳入研究仅1个研究提及随机分配方法,余均未介绍具体的随机及分配方法,也未提到分配隐藏。干预措施实施环节和终点指标测量环节均未提及盲法。存在选择性偏倚、实施偏倚和测量性偏倚的高度可能性,故质量等级均为"C"级。Meta分析结果显示,与试验组和对照组宫内感染发生率分别为15.3%、41.2%,RR 0.38,95%CI(0.27,0.54),两组比较差异有统计学意义(P<0.000 01)。经亚组分析和敏感性分析,均提示该Meta分析结果具有较好的稳定性。此外,无论是孕妇还是新生儿,均没有报道与HBIG相关的不良反应。结论:经系统评价,与对照组相比,孕晚期使用HBIG能显著降低新生儿HBV宫内感染发生率,且未见相关不良反应。

应用HBIG阻断新生儿HBV宫内感染的研究

目的探讨乙肝免疫球蛋白(HBIG)对高乙肝病毒(HBV)载量孕妇宫内感染阻断。方法 2009年1月至2012年5月选择我院高HBV载量孕妇139例:HBsAg、HBeAg和(或)抗HBe和抗HBc阳性、HBV-DNA≥1.0×107拷贝/mL。随机分观察组79例和对照组60例。观察组孕妇28、32、36 w肌注HBIG200IU,对照组孕期不采取特殊措施。二组新生儿出生6 h内肌注HBIG100 IU,乙肝疫苗全程接种,采集出生及12月龄静脉血,检测HBsAg、抗HBs、HBeAg、抗HBe、抗HBc和HBV-DNA。结果新生儿HBV宫内感染率观察组10.1%(8/79)低于对照组31.7%(19/60),两组差异有统计学意义(P<0.05)。新生儿持续至12月龄,HBV慢性感染率观察组8.9%(7/79)低于对照组23.3%(14/60),两组差异有统计学意义(P<0.05);HBV阻断率观察组91.1%(72/79)高于对照组76.7%(46/60),两组差异有统计学意义(P<0.05);免疫成功率观察组77.2%(61/79)高于对照组66.7%(40/60),但两组差异无统计学意义(P>0.05)。结论高HBV载量孕妇孕末期应用HBIG可降低新生儿HBV宫内感染率及慢性感染率,提高HBV母婴传播阻断率。

Prevention of intrauterine infection by hepatitis B virus with hepatitis B immune globulin:efficacy and mechanism

Objective To evaluate the efficacy of hepatitis B immune globulin (HBIG) in preventing intrauterine infection by hepatitis B virus (HBV) and to investigate its mechanism. Methods Forty eight pregnant women positive for hepatitis B surface antigen (HBsAg) were randomly divided into 2 groups. The 34 women in the study group were injected with HBIG during pregnancy; the other 14 women were controls. Maternal blood samples were taken before HBIG injection and at delivery. Neonatal blood samples were taken within 24 hours after birth before HBIG and hepatitis B vaccine were given. HBsAg and antibody to HBsAg (anti HBs) were tested by radioimmunoassay. Results None of the 35 newborns (including 2 twins) in the study group was positive for HBsAg, but 3 (21%) in the control group were positive (P=0.02). The HBsAg titers in the women in the study group decreased after HBIG injection. Of the 35 newborns in the study group, 32 (91%) were positive for anti HBs. Conclusion Systematic injections of HBIG during pregnancy may prevent intrauterine HBV infection, the mechanism of which may be reduction of maternal HBV viremia and production of fetal passive immunity.

替比夫定治疗HBeAg阳性慢性乙型肝炎和肝硬化患者血清免疫球蛋白和补体水平的变化

目的观察HBe Ag阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后血清免疫球蛋白Ig G、Ig A、Ig M和补体C3、C4的变化,探讨替比夫定治疗对于患者体液免疫功能的影响。方法选择35例HBe Ag阳性慢性乙型肝炎和22例乙型肝炎肝硬化患者,给予替比夫定抗病毒治疗,于治疗前和治疗后3个月、6个月,采用免疫透视比浊法检测血清免疫球蛋白Ig G、Ig A、Ig M和补体C3、C4。结果在治疗前,慢性乙型肝炎患者血清Ig G水平为(16.21±2.54)mg/L,显著低于肝硬化患者的[(19.42±2.95)mg/L,P<0.05];在治疗6个月时,肝硬化患者血清Ig A水平为(1.41±0.18)mg/L,显著高于慢性乙型肝炎患者的[(1.26±0.17)mg/L,P<0.05];在其他各时间点比较,两组患者血清免疫球蛋白和补体水平无显著性相差(P>0.05)。结论 HBe Ag阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后机体体液免疫功能有一定程度的恢复。

减弱乙肝HBeAg阳性孕妇母婴传播力度的研究

目的 探讨用乙肝免疫球蛋白经母亲对胎儿进行被动免疫 ,减弱HBeAg阳性孕妇乙型肝炎病毒 (HBV)母婴传播的力度。 方法 采用前瞻性随机对照研究方法 ,将新疆 4所医院 1997年至 2 0 0 2年 5月产前检查资料完整、HBeAg阳性的 5 2例孕妇随机分为两组 ,试验组 2 8例 ,分别在孕 2 8、32及 36周各肌注乙肝免疫球蛋白 (HBIG) 2 0 0IU 1次 ;对照组 2 4例 ,每月只随访和体检 ,不肌注HBIG。分娩后采集两组新生儿脐血 ,分离血清 ,用ELISA法和荧光定量PCR法检测HBeAg和HBV DNA。 结果 试验组新生儿HBeAg阳性率为 2 1 4 % ,对照组新生儿HBeAg阳性率为 79 2 % ,其差异有统计学意义 (χ2 =17 2 6 ,RR =0 2 7,P <0 0 1) ;试验组新生儿HBV DNA阳性率为 2 5 0 % ,对照组新生儿HBV DNA阳性率为 83 3% ,其差异也有统计学意义 (χ2 =17 6 2 ,RR =0 30 ,P <0 0 1)。试验组新生儿HBV DNA阴性 2 1例 ,阳性 7例 ,但这 7例新生儿HBV DNA的量均低于其母 ,其差异有统计学意义 (经Wilcoxon配对法秩和检验 ,统计量T =2 8,P =0 0 2 )。 结论 对乙肝HBeAg阳性孕妇产前多次肌注HBIG可明显减弱HBV母婴传播力度。

HBV孕妇注射乙肝免疫球蛋白阻断HBV母婴垂直传播的免疫机制

目的:探讨母体注射乙肝免疫球蛋白(HBIG)阻断HBV母婴垂直传播的被动免疫效果和机制。方法:选取本院收治的慢性乙型病毒性肝炎孕产妇94例,随机分为对照组31例,婴儿干预组31例,和母婴共干预组32例;对照组不给予HBIG干预,婴儿干预组在婴儿出生6 h之内给予HBIG干预,母婴共干预组分别在母体孕28、32、36周和婴儿出生6 h之内给予HBIG干预;此外,三组新生儿均在出生后0、1、6月接种乙肝疫苗,并于末次接种后取患儿空腹外周血,进行乙肝标记物、HBV-DNA及免疫功能检测。结果:三组新生儿HBe Ag、HBs Ag、HBV-DNA阳性率有显著性差异(P<0.05),以对照组为最高,母婴共干预组最低;HBe Ab阳性率亦有显著性差异(P<0.05),以对照组为最低,母婴共干预组最高。三组新生儿的补体C3、C4水平及T淋巴细胞亚型CD3+T、CD4+T、CD8+T计数均有显著性差异(P<0.05),以对照组为最低,母婴共干预组最高;在免疫球蛋白方面,婴儿干预组和母婴共干预组的Ig G、Ig M显著高于对照组(P<0.05),而Ig A无明显组间差异(P<0.05)。结论:母体HBIG注射可有效激活母体的体液免疫和细胞免疫,降低母体中病毒含量。此外,通过胎盘对胎儿的影响,协同使新生儿产生抗原-抗体反应,缓解HBV病毒所诱发的T淋巴细胞耗损,有可能发挥其对HBV母婴垂直传播的阻断作用。

乙肝疫苗和乙肝免疫球蛋白联合接种对母亲HBsAg阳性的新生儿感染情况的影响

目的:探讨乙肝疫苗和乙肝免疫球蛋白联合接种对母亲HBsAg阳性的新生儿感染情况的影响。方法:选取患有HBsAg阳性的母亲于我院接受产前检查并住院分娩所生的新生儿200例为研究对象,按照自愿原则,将其均分为对照组和观察组。对照组新生儿出生后24h、1个月、6个月进行乙肝疫苗和乙肝球蛋白联合接种100IU,观察组产妇在孕周27、30、33、36周连续进行免疫球蛋白注射,每次200IU,新生儿出生后24h、1个月、6个月进行乙肝疫苗和乙肝球蛋白联合接种100IU。新生儿出生12个月之后,观察两组新生儿感染情况以及两组产妇不同的分娩方式对新生儿感染的影响。结果:观察组新生儿HBsAg阳性率和HBsAb阳性率均明显低于对照组,差异具有统计学意义(P<0.05);顺产的新生儿HBsAg阳性率为7例,其中观察组为1例,对照组有6例。剖腹产的新生儿HBsAg阳性率为4例,均为对照组新生儿。无论是顺产还是剖腹产新生儿HBsAg阳性率观察组都明显少于对照组(P<0.05)。结论:无论采用顺产还是剖腹产分娩的新生儿,乙肝疫苗和乙肝免疫球蛋白联合接种均可以有效降低新生儿HBsAg阳性患病率。

HBsAg阳性产妇分娩婴儿乙肝免疫接种低和无应答的影响因素

目的探讨可能导致HBsAg阳性产妇分娩的婴儿乙肝免疫接种后免疫低和无应答的因素。方法回顾性分析2013-2014年在首都医科大学附属北京佑安医院收治的HBsAg阳性产妇分娩的832例新生儿的临床资料,新生儿出生后6 h内及21 d接种乙型肝炎免疫球蛋白200 IU,出生当天和出生后1、6个月注射乙型肝炎疫苗10μg。出生后6 h内、7月龄抽取股静脉血,检查HBV标志物和HBV DNA定量。按照产妇孕期是否接受抗病毒治疗、母乳喂养、父亲HBsAg情况、母亲HBeAg情况分组,评估上述因素对婴儿乙肝免疫接种应答情况的影响。结果产妇孕期接受抗病毒治疗组的婴儿低和无应答率为8.6%（25/290）,未行抗病毒治疗组的婴儿低和无应答率为7.0%（38/542）,差异无统计学意义（χ2=0.60,P=0.44）。母乳喂养组婴儿的低和无应答率为8.8%（18/204）,人工喂养组低和无应答率为7.2%（45/628）,差异无统计学意义（χ2=0.52,P=0.47）。父亲HBsA g阳性组的婴儿低和无应答率为20.0%（5/25）,父亲HBsAg阴性组的婴儿低和无应答率为27.2%（58/807）,差异无统计学意义（χ2=3.00,P=0.08）。母亲HBeAg阳性组的婴儿低和无应答率为9.9%（33/335）,母亲HBeAg阴性的婴儿低和无应答率为6.0%（30/497）,差异无统计学意义（χ2=3.55,P=0.06）。结论 HBsAg阳性产妇分娩的婴儿中,母亲孕期采用抗病毒治疗、母乳喂养、父亲HBsAg阳性和母亲HBeAg阳性对婴儿乙肝免疫应答无明显影响。

乙肝免疫球蛋白与乙肝疫苗联合免疫阻断HBV母婴传播3年效果观察

目的 通过连续 3a的前瞻性观察 ,研究乙肝免疫球蛋白 (HBIG)与乙肝疫苗 (Hep -B疫苗 )联合免疫阻断HBV母婴传播的效果及乙肝疫苗的免疫持久性。方法 该研究设实验组Ⅰ、实验组Ⅱ和 1个对照组 ,用酶联免疫吸附试验 (ELISA)法检测HBsAg和抗 -HBs。结果 通过 3a的阻断效果观察 ,实验组ⅠHBsAg阻断率为 10 0 % ,实验组ⅡHBsAg阻断率为91 67% ;对照组HBsAg阻断率为 10 0 %。结论 证实联合免疫对阻断HBV母婴传播有效。通过 3a的实验观察 ,实验组和对照组抗 -HBs阳性率呈逐年下降 。

肝移植围手术期HBV再感染的预防

目的探讨乙型肝炎病毒(HBV)相关疾病患者肝移植围手术期HBV再感染的预防措施。方法回顾近年相关文献并进行综述。结果对患HBV相关的急、慢性肝病的肝移植患者,预防移植后HBV再感染至关重要。目前不仅有多种预防HBV再感染的药物应用于临床,而且针对患者不同特点,在预防方案方面也有新的研究进展。结论肝移植是治疗HBV相关疾病的有效方法,围手术期合理准确地选择预防HBV再感染方案对延长患者肝移植术后存活期有重要意义。

孕中不同时期联合免疫对HBV母婴传播的阻断效果

目的探讨不同时期注射乙肝疫苗联合乙肝免疫球蛋对乙型肝炎病毒母婴传播的阻断作用。方法以HBsAg阳性孕妇及其婴儿为研究对象,A组105例于孕20周、24周、28周注射乙肝免疫球蛋白200 IU。B组106例孕妇于28周、32周、36周同法注射。两组新生儿出生后半小时内进行乙肝疫苗10μg、乙肝免疫球蛋白200 IU肌肉注射。结果 A组和B组新生儿出生时脐带静脉血、12月、24月外周静脉血HBsAg阳性率、HBsAb阳性率比较经χ2检验均有显著性差异(P<0.05)。结论对HBsAg阳性孕妇孕20周、24周、28周及新生儿联合使用乙肝疫苗、乙肝免疫球蛋白可以有效减低HBV感染率。