异基因造血干细胞移植术后乙型肝炎的临床特点

目的探讨异基因造血干细胞移植患者乙型肝炎的临床表现、病理、自然史.方法总结合并HBV感染的异基因造血干细胞移植患者10例,其乙型肝炎发病时临床和肝组织病理资料.血清丙氨酸氨基转移酶（ALT）、γ谷氨酰转肽酶（GGT）采用速率法,血清总胆红素（TBIL）采用终点比色法检测;乙型肝炎病毒血清标志物采用酶免疫测定（EIA）,HBV DNA定量测定采用聚合酶链反应（PCR）试剂盒.其中8例进行了肝组织活检.结果 （1）5例患者有慢性乙型肝炎病史,5例患者有乙型肝炎家族史,4例患者有HBV暴露史.（2）移植前10例患者肝功能指标包括ALT、TBIL、GGT均正常,而在乙型肝炎发作时上述指标均显著升高.（3）移植前受者的乙型肝炎免疫性检测为1例患者 HBsAg阳性、HBeAg阳性、抗-HBc阳性;1例患者抗-HBs阳性、抗-HBc阳性;3例患者仅抗-HBc阳性;4例患者HBsAg阳性、抗-HBe阳性、抗-HBc阳性;1例患者仅抗-HBs阳性.（4）3例患者肝脏病理学诊断为纤维化瘀胆性肝炎,4例患者诊断为慢性乙型肝炎,1例患者诊断为急性乙型肝炎.（5）在随访终点时,5例患者死于重型肝炎,1例患者死于肺炎,3例患者发展为慢性乙型肝炎,1例患者痊愈.结论 （1）HSCT术后乙型肝炎患者常有乙型肝炎病史、乙型肝炎家族史或HBV暴露史.（2）HSCT乙型肝炎患者的临床特点、病理、自然史不同于正常免疫状态的乙型肝炎患者.

Clinical features of the patients with hepatitis B after allo-genetic hemopoietic stem cell transplantation

Objective To investigate clinical signs, liver histology and natural history of allo-genetic hemopoietic stem cell transplantation patients with hepatitis B.Methods Clinical data of 10 cases with hepatitis B after allo-genetic hemopoietic stem cell transplantation were summarized and analyzed. These cases were subjected to liver biochemical tests, HBV serologic assays (ELISA) and HBV DNA assays. 8 patients were taken liver biopsy.Results Five patients had hepatitis B history ,five patients had hepatitis B family history and four patients had exposed to HBV. Liver functions were remarkably abnormal for patients with hepatitis B after allo-genetic hemopoietic stem cell transplantation. Three patients were diagnosed fibrosing cholestatic hepatitis, four patients were diagnosed chronic hepatitis B and one patients was acute hepatitis B by liver histology. Five patients died for liver failure and three patients developed chronic hepatitis B in the end of follow-up.Conclusions (1)Most patients with hepatitis B after HSCT had hepatitis B history or hepatitis B family history or had exposed to HBV.(2)It may be different for the clinical and liver histological data and natural history of hepatitis B between hemopoietic stem cell transplantation patients with hepatitis B and immunocompetent patients.