拉米夫定预防肝移植术后乙型肝炎病毒再感染的研究

目的 探讨和评价拉米夫定预防原位肝移植术后乙型肝炎病毒（HBV）再感染的效果。方法 41例患者，术前诊断为肝炎后肝硬化（失代偿期）者22例，慢性重型肝炎并肝炎后肝硬化（失代偿期）者12例，慢性重型肝炎者7例，其中HBVDNA阳性16例。41例患者均采用背驮式原位肝移植，术前15例给予拉米夫定治疗，术后41例患者均服用拉米夫定。结果 10例患者术后出现HBV再感染，其中9例为YMDD变异毒株感染，术后1、2年的HBV再感染率分别为9．8％（4／41）、24．4％（10／41）。术前血清HBVDNA阴性者术后HBV再感染率（12．0％，3／25）明显低于HBVDNA阳性者（43．8％，7／16）。术前长期服用（超过6个月）拉米夫定者和未服用拉米夫定者术后HBV再感染率分别为66．7％、23．1％，均明显高于术前短期（未超过6个月）服用拉米夫定者（0，P〈0．05）。结论 术前服用拉米夫定可降低乙型肝炎患者肝移植后HBV再感染率，但服药时间不宜超过6个月；长期、单一的应用拉米夫定易导致病毒变异而出现耐药毒株感染。

Efficacy of lamivudine for prevention of hepatitis B virus reinfection after liver transplantation

Objective To investigate the effect of lamivudine for the prevention of hepatitis Bvirus reinfection in post-orthotopic liver transplantation (OLT) patients.Methods Clinical data of 41adult patients followed up for 2 years after liver transplantation,who received lamivudine prophylactic strategy for HBV reinfection,were analyzed retrospectively.Results Ten cases developed hepatitis B virus(HBV) reinfection,and 9 of them were caused by LAM-resistant HBV(YMDD).The one-and 2-year rate of HBV reinfection after transplantation was(9.8 %)(4/41) and(24.4 %)(10/41) respectively.The reinfection rate of group with negative preOLT serum HBV DNA was much lower than in the HBV DNA positive group.The reinfection rate of group receiving long-term(more than 6 months) lamivudine treatment and group not receiving anti-virus treatment pre-OLT was(66.7 %) and(23.1 %),respectively.Both of them were remarkably higher than in the group receiving short-term less than 6 months lamivudine treatment.Conclusions The short-term(less than 6 months) lamivudine treatment pre-OLT can suppress serum HBV DNA replication effectively,and long-term more than 6 months lamivudine treatment pre-OLT can decline the rate of HBV reinfection obviously.But the prophylaxis of long-term LAM monotherapy may induce LAM-resistant HBV variants(YMDD) reinfection.