肝移植受者术后早期发生获得性丙型肝炎病毒感染三例

目的 分析肝移植术后早期发生获得性丙型肝炎病毒(HCV)感染的临床特点,总结诊断和治疗经验.方法 回顾性分析3例肝移植术后早期发生获得性HCV感染受者的临床资料,评价HCV-RNA检测方法对肝移植术后发生获得性HCV感染的诊断价值,观察丙氨酸转氨酶(ALT)与他克莫司(FK506)的血药浓度、用药剂量及浓度/剂量比值的变化特点.结果 与抗-HCV及移植肝活组织HCV抗原检测相比,HCV-RNA检测可更早确诊HCV感染.3例术后早期发生获得性HCV感染的受者均出现FK506血药浓度异常升高,并伴随出现ALT水平及FK506血药浓度/剂量比值的异常升高.结论 HCV-RNA检测是确诊肝移植术后早期发生获得性HCV感染的最佳方法;确诊后应调整FK506的用药剂量,使其血药浓度维持在治疗窗内,并积极保护移植肝功能.

The diagnosis and therapy of early De novo hepatitis C virus infection after liver transplantation

Objective To analyze the clinical features of early De novo hepatitis C virus infection after liver transplantation and summarize the experience of diagnosis and therapy. Methods Three cases of early De novo hepatitis C infection after liver transplantation were retrospectively. The diagnostic value of HCV-RNA test was estimated,the changes in glutamate-pyruvate transaminase(ALT),tacrolimus(FK506) concentration level,dosage and level/dosage ratio were observed. Results Blood HCV-RNA test confirmed early De novo hepatitis C infection after liver transplantation earlier than blood HCV-Ab test and liver biopsy HCV-Ag test(NS3 staining). FK506 concentration in all cases was increased significantly after operation,at the same time, ALT level and the FK506 level/dose ratio rised abnormally. Conclusions HCV-RNA test is the best method to diagnose early De novo hepatitis C infection after liver transplantation. FK506 dosage should be adjusted after confirming diagnosis and protection of liver function is needed.