肝移植术后乙型肝炎病毒再感染的防治

目的探讨单一应用拉米夫定（LMV）预防肝移植术后乙型肝炎病毒（HBV）再感染的疗效及再感染后抗病毒治疗的疗效。方法回顾性研究单一应用LMV预防HBV再感染的15例肝移植患者，检测肝移植手术前、后乙型肝炎表面标记物及HBV-DNA的变化。结果4例患者术后发生HBV再感染，1a、2a的再感染率分别为6．7％（1／15）和26．7％（4／15），予以阿德福韦酯治疗，效果良好。结论LMV可以有效的预防肝移植术后HBV的再感染；阿德福韦酯可以安全有效的降低HBVDNA的复制，防止因HBV对LMV耐药引起的对移植肝的损害和病人病情的恶化。

Prevention and treatment for reinfection of HBV after liver transplantation

Objective to investigate the prophylactic effect of lamivudine monotherapy on the reinfection of hepatitis B virus after liver transplantation and the effect of the treatment by nucleotide analogs. Metheds Clinical data of 15 adult patients followed up for 2 years after liver transplantation, who received lamivudine prophylactic strategy for HBV reinfection, were analyzed retrospectively. Results Four cases developed HBV reinfection. The one and two-year rate of HBV reinfection after liver transplantation was 13.3% （2/15） and 26.7% （4/15） respectively. Adefovir dipivoxil was administered and HBV DNA levels by PCR were reduced, even undetectable after treatment. Conclusions It is effective for the patients to take lamivudine to prevent the HBV reinfection after liver transplantation. The nucleotide drug （adefovir） is effective and save to inhibit the＇ replication of HBV and prevents clinical deterioration of patients affected with the development of LAM resistant HBV.