原位肝移植术后乙型肝炎病毒再感染的预防(附68例报告)

目的探讨原位肝移植术后乙型肝炎病毒(HBV)再感染的预防。方法68例病人分别为慢性乙型重型肝炎、终末期肝硬化和肝硬化合并肝癌病人,移植前后给予抗病毒药物预防HBV再感染,拉米夫定2例,拉米夫定加乙型肝炎免疫球蛋白(HBIG)63例,阿德夫韦加HBIG3例;观察预防性治疗后的临床表现、血清HBV、HBVDNA及肝活检免疫组织化学法检测等指标。结果应用拉米夫定的2例病人,有1例发生再感染,其血清HBsAg、抗Hbe、抗HBc和HBVDNA均呈阳性,肝活检免疫组织化学检测有HBsAg表达。用拉米夫定加HBIG预防的63例中,有2例再感染,血清均呈HBsAg、抗HBe和抗HBc阳性,肝活检免疫组织化学法检测有HBsAg表达,其中1例血清HBVDNA阳性。用阿德夫韦加HBIG预防的3例中,血清学和肝活检免疫组织化学法检测均无HBsAg表达。结论原位肝移植术是治疗HBV感染相关的终末期肝病的有效手段,拉米夫定加HBIG或阿德夫韦加HBIG联合应用可以有效地预防HBV的再感染。

Prevention of hepatitis B virus reinfection following orthotopic liver transplantation

Objective To discuss the preventive measures of hepatitis B virus reinfection following orthotopic liver transplantation. Methods Sixty-eight cases of chronic fulminant hepatitis B, end-stage liver cirrhosis and liver carcinoma were given anti-viral drugs pre-and post-transplantaton to prevent hepatitis B virus reinfection. Lamivudine was administered in 2 cases; lamivudine hepatitis Bimmunoglobulin (HBIG) in 63 cases; Adefovir HBIG in 3 cases. The follow-up criteria included serum HBV, HBV DNA, liver biopsy immunohistochemical study of liver biopsy specimens and clinical manifestations. Results One of the 2 cases given lamivudine developed reinfection, whose serum anti-HBsAg , anti-HBe,anti-HBc ,HBV DNA were positive and liver specimen immunohistochemical study showed HBsAg phenotype. Two of 63 cases given lamivudine HBIG developed reinfection, and the serum anti-HBs?anti-HBe,anti-HBc were positive and liver specimen immunohistochemistry showed HBsAg phenotype; serum HBV DNA was positive in one of the cases. The cases given adefovir developed no HBV reinfection. Conclusions Orthotopic liver transplantation is an effective treatment for HBV-related end-stage liver diseases. Lamivudine HBIG or Adefovir HBIG offers effective prevention against hepatitis B virus reinfection.