173例肝移植术后乙型肝炎病毒再感染防治经验回顾

目的 探讨原位肝移植术后乙型肝炎病毒再感染的预防。方法 回顾性分析了173例乙肝相关性肝病病人，移植前后给予抗病毒药物预防乙型肝炎病毒再感染，拉米呋啶2例，拉米呋啶＋乙肝免疫球蛋白（HBIg）166例，阿德福韦＋HBIg5例，观察临床表现、血清HBV、HBVDNA及肝活检免疫组织化学检测等指标。结果 应用拉米呋啶预防的2例病人，有1例再感染，其血清HBsAg、HBeAb、HBcAb和HBVDNA均阳性，肝活检免疫组织化学检测有HBsAg表达。用拉米呋啶＋HBIg预防的166例中，有3例再感染，血清均HBsAg、HBeAb和HBcAb阳性，肝活检免疫组织化学检测有HBsAg表达，其中1例血清HBVDNA阳性，有1例经治疗后HBsAg又转阴。用阿德福韦＋拉米呋啶＋HBIg预防的5例中，血清学和肝活检免疫组织化学检测均无HBsAg表达。结论 原位肝移植术是治疗HBV相关性终末期肝病的有效手段，拉米呋啶＋HBIg或拉米呋啶＋阿德福韦＋HBIg联合应用可以有效预防乙型肝炎病毒的再感染。

Prevention of HBV reinfection after orthotopic liver transplantation

Objective To investigate the prevention of HBV reinfection after orthotopic liver transplantation (OLT). Methods A total of 173 patients with chronic fulminant hepatitis B, end-stage of liver cirrhosis and liver carcinoma complicated with HBV cirrhosis were given anti-viral drugs before and after OLT to prevent HBV reinfection. Lamivudine was administered in 2 patients (group A), lamivudine+HBIg in 166 (group B )and lamivudine + adefovir+HBIg in 5 (group C). The serum HBV and HBV DNA were determined and liver biopsy immunohistochemical examination and clinical observation performed. Results In group A, 1 patient had reinfection and there was positivity of HBsAg, HBeAb, HBcAb and HBV DNA. Liver biopsy immunohistochemistry showed that there was HBsAg phenotype. In group B, 3 patients had reinfection and there was positivity of HBsAg, HBeAb and HBcAb. Liver biopsy immunohistochemistry showed that there was HBsAg phenotype. The serum HBV DNA was positive in one of them. HBsAg phenotype was negative after therapy in 1 patient. In group C, none of the patients had reinfection. Conclusions OLT is an effective treatment for HBV infection-related diseases. Lamivudine+HBIg or lamivudine+adefovir+HBIg can effectively prevent HBV reinfection after OLT.