乙型肝炎后肝硬化肝移植乙型肝炎病毒再感染检测

目的探讨乙型肝炎病毒（HBV）DNA、YMDD变异及血清标志物在乙型肝炎肝硬化患者肝移植后HBV再感染检测的临床意义。方法定量聚合酶链反应（PCR）检测HBV DNA；HBV PCR产物限制性片段长度多态性分析检测YMDD变异；酶联免疫检测HBV血清标志物；分析乙型肝炎患者肝移植后YMDD变异、HBV DNA及血清标志物检测结果。结果乙型肝炎肝硬化患者肝移植术后HBV再感染率为8．9％（17／189）；YMDD变异病例达HBV再感染病例58．8％（10／17）；HBV DNA定量检测有较高的灵敏度，能早期诊断HBV的再感染，有利于临床治疗；对HBV DNA阴性但HBsAg阳性病例，PreS1和HBeAg血清标志物可用于病毒复制的补充检测。结论乙型肝炎肝硬化患者肝移植后预防乙型肝炎复发应采用HBV DNA、YMDD变异及血清标志物联合检测。

Detection of HBV reinfection post-transplantion in liver transplant recipients with HBV hepatitis

Objective To investigate the clinical significance of HBV DNA, YMDD variants and HBV serum markers after liver transplantation in the recipients with hepatitis B. Methods YMDD variants were assayed by PCR-RFLP;HBV DNA was detected by quantitative polymerase chain reaction assay; HBV serum markers were assayed by ELISA. Results The positive rate of reinfection after liver transplantation was 8.9% (17/189).The cases having YMDD variants accounted for 58.8% of reinfection cases (10/17). The quantitative polymerase chain reaction assay of HBV DNA was sensitive for the earlier diagnosis of HBV reinfection after liver transplantation and beneficial to the clinical treatment. The detection of both PreS1 and HBeAg in serum could be applied to determine HBV replication in the cases positive for HBsAg and negative for HBV DNA. Conclusion The combination detection of YMDD variants, HBV DNA and HBV serum markers may define HBV reinfection after liver transplantation in the patients with hepatitis B.