乙型肝炎相关肝移植受体供肝植入前后乙型肝炎病毒标志物的变化

目的 了解乙型肝炎相关受体在拉米夫定或拉米夫定 乙型肝炎免疫球蛋白(HBIG)预防下供肝植入前后移植物乙型肝炎病毒(HBV)标志物的变化，探讨移植物HBV再感染的可能机制，为预防复发寻找切入点。方法用酶联放射免疫法、HBVDNA荧光定量法、免疫组织化学LSAB法定期检测78例受体手术前后血清及90例供肝活检组织，重点观察供肝植入前后HBV标志物在肝组织及血清中的动态变化。结果移植时无论受体为HBV活跃复制状态或非活跃复制状态，供肝植入后2h内活检肝组织既无HBVDNA又无HBsAg、HBcAg阳性证据。结论在现有预防措施下，无论受体术前HBV复制状态如何，健康供肝无术中HBV颗粒直接感染的证据，其机制及在远期HBV再感染中的意义尚待进一步研究。

Investigation on the alteration of hepatitis B virus (HBV) markers in liver allograft of HBV related recipients in perioperative period

Objective To investigate the alteration of HBV markers in liver allograft of HBV related recipients preand post liver transplantation under Lamivudine or combination of Lamivudine with HBIG prophylaxis and explore themechanism of HBV de nova infection in liver allograft after orthotopic liver transplantation, as well as seek to establish aoptimal prophylactic protocol. Methods The serial liver biopsy specimens of 90 liver allograft and sera of 78 livertransplant recipients during operation and after 1 week, 1 month, 3 months, 6 months, 12 months, 24 months posttransplantation have been collected and detected for HBV markers with Enzyme-linked radioimmunoassay, fluorescentquantitative assay for HBV-DNA in serology and with immunohistochemistry stain, HBV-DNA in situ hybridization inhistology for detection of HBV markers in liver allograft samples. Results Whether recipients with active replicative orinactive replicative HBV preoperatively, none of positive HBV-DNA, HBsAg and HBcAg in 100% liver biopsy specimenswith HBV-DNA hybridization in situ and immunohistochemistry stains in histology within 2 hours after reperfusion.Conclusion Whatever HBV replicative status the recipients have before surgery, no evidence of HBV particles directinvasion to the liver allograft from HBV related cirrhotics during operation under current prophylactic measures. However, thefurther supposed mechanism and its significance in HBV de nova infection of liver allograft remained to be disclosed further.