拉米夫定联合小剂量乙型肝炎免疫球蛋白预防肝移植术后乙型肝炎病毒复发

目的:初步探讨拉米夫定联合小剂量乙型肝炎免疫球蛋白预防肝移植术后乙型肝炎病毒(HBV)复发的疗效。方法:35例HBV相关疾病病人接受肝移植后使用拉米夫定联合小剂量乙型肝炎免疫球蛋白(HBIg)预防HBV复发,同时监测乙型肝炎血清标志物、血清HBV鄄DNA、YMDD区变异及肝活检组织乙型肝炎标记物免疫组化。结果:本组病例平均获随访557d,结果5例(14.3%)出现了HBV复发:复发病例中2例HBV鄄DNA阳性,无YMDD变异。病人术前HBeAg状态与肝移植术后HBV复发间无明显相关(P>0.05),而术前HBV鄄DNA阳性的病人术后HBV复发率显著增加(P<0.05)。结论:拉米夫啶联合小剂量HBIg预防肝移植术后HBV复发的近期疗效较为肯定。术前HBV鄄DNA状态是影响术后HBV复发的重要因素。

The use of Lamivudine combined with low-dosage hepatitis B immunoglobulin to prevent recurrence of hepatitis B virus after liver transplantation

Objective To explore the curative effect of Lamivudine combined with low-dosage hepatitis B immunoglobulin to prevent recurrence of hepatitis B virus(HBV) after liver transplantation. Methods Thirty-five submitted to liver transplantation used Lamivudine combined with low-dosage hepatitis B immunoglobulin to prevent recurrence of HBV; meanwhile, the marker of hepatitis B, HBV-DNA and YMDD variant were monitored; liver biopsy testified the marker of hepatitis B by immunohistology. Results The duration of follow-up was 557 days in average. The recurrence rate of HBV was 14.3%(5 cases). In the patients with recurrence, there were 2 cases with positive HBV-DNA and no YMDD variant was detected. The state of HBeAg before liver transplantation had no apparent relationship with HBV recurrence(P>0.05), while the positiveness of HBV-DNA did bear significant relationship with it (P<0.05). Conclusions The short-term curative effect on HBV recurrence by Lamivudine combined with low-dosage hepatitis B immunoglobulin is witnessed. The state of HBV-DNA before liver transplantation is a vital factor for HBV recurrence after liver transplantation.