重型乙型肝炎肝移植术后乙型肝炎病毒再感染的防治

目的探讨重型乙型肝炎肝移植术后乙型肝炎病毒(HBV)再感染的防治。方法回顾性分析了73例重型乙型肝炎患者,移植前后给予抗病毒药物预防乙型肝炎病毒再感染,拉米夫定 乙肝免疫球蛋白(HBIG)71例,阿德夫韦 拉米夫定 乙肝免疫球蛋白2例,观察临床表现、血清HBSAg、血清HBeAg、血清HBV DNA及肝活检免疫组织化学检测等指标。结果应用拉米夫定 HBIG预防的71例中,有2例再感染,血清HBSAg为阳性,肝活检免疫组织化学检测有HBSAg表达,其中1例血清HBV DNA阳性,另1例经治疗后HBSAg又转阴。用阿德夫韦 拉米夫定 HBIG预防的2例中,血清学和肝活检免疫组织化学检测均无HBSAg表达。结论拉米夫定 HBIG或拉米夫定 阿德夫韦 HBIG联合应用以及合理的使用免疫抑制剂可以有效预防重型乙型肝炎患者移植术后乙型肝炎病毒的再感染。

PREVENTION AND TREATMENT OF HEPATITIS B VIRUS REINFECTION AFTER LIVER TRANSPLANTATION FOR SEVERE HEPATITIS B

Objective To discuss the prevention and treatment of hepatitis B virus reinfection after liver transplantation for severe hepatitis B.Methods 73 cases of severe hepatitis B were given anti-viral drugs pre and post transplantation to prevent hepatitis B virus reinfection. Lamivudine HBIG in 71 cases, lamivudine adefovir HBIG was administered in 2 cases. The serum HBSAg, serum HBeAg , HBV DNA, liver biopsy immunohistochemistry and clinical were performed.Result 2 of 71 cases given lamivudine HBIG developed reinfection, which serum HBSAg was positive and liver biopsy immunohistochemistry showed HBSAg phenotype. The serum HBV DNA was positive in one of them. The serum HBSAg phenotype of one case was negative after therapy. 2 cases given adefovir developed no reinfection with HBV.Conclusion Lamivudine HBIG or lamivudine adefovir HBIG and proper use of immunosuppressant could effectively prevent hepatitis B virus reinfection after liver transplantation for severe hepatitis B.