供受者感染乙肝病毒对造血干细胞移植后肝炎复发及愈后的影响

目的分析移植前供、受者感染乙肝病毒对造血干细胞移植后肝炎复发及愈后的影响。方法对上海第一人民医院2006年1～11月移植前供、受者感染乙肝病毒的23例恶性血液病患者,进行移植前后肝功能、乙肝免疫标记物、HBVDNA等检测,并结合临床综合分析。血清丙氨酸氨基转移酶（ALT）、γ谷氨酰转肽酶（GGT）采用速率法,血清总胆红素（TBIL）采用终点比色法检测;乙肝病毒血清标志物采用酶免疫测定（EIA）;HBVDNA测定采用聚合酶链反应（PCR）试剂盒。结果①9例HBV感染的自体移植患者移植后3例发生乙型肝炎,其中2例为移植前HBsAg阳性,乙肝发作时3例HBVDNA及肝功能指标均明显增高;②14例HBV感染的供、受者移植后5例患者发生乙型肝炎,HBVDNA及肝功能指标均明显增高;③移植前HBsAg或HBVDNA阳性移植后发生乙肝相关性肝损的几率显著高于阴性组（X^2分别为8.44、9.07,均大于X0.005^2,P〈0.005）;④移植前HBsAg或HBVDNA阳性对移植预后均无影响（X^2分别为2.58、0.24,均小于X0.05^2,P〉0.05）;⑤1例患者异体移植后41d,乙肝合并戊肝,发生急性黄疸性肝炎,第46天重症GVHD死亡。结论移植前HBsAg和HBVDNA阳性均是HBV感染和再激活的高危因素,移植要密切监测免疫标志物和HBVDNA。移植前HBsAg和HBVDNA阳性不影响患者的生存,要注意非常见肝炎的多重感染。

Impact of Hepatitis B Virus Infection of Donors and Recipients on the Recurrence of Hepatitis B after Transplantation of Hematopoietic Stem Cells

Objective To investigate the impact of hepatitis B virus （HBV） infection of recipients and/or donors on the recurrence of hepatitis B after hematopoietic stem cell transplantation （HSCT）. Method Prior transplantation, 23 subjects were analyzed for the liver function, serological markers of HBV （ELISA） and HBV DNA （PCR）. The levels of serum ALT and GGT were measured with rate method, TBIL was determined using endpoint colorimetric method. All the 26 donors and recipients were found to have HBV infection before HSCT. Result ①Three out of nine HBV-infected patients receiving autotransplantation developed hepatitis B after auto-HSCT.②Five out of fourteen HBV-infected patients developed hepatitis B after allogenic HSCT. Both liver function, serological markers for HBV, and the level of HBV DNA were remarkably increased. ③The incidence of hepatitis in patients and/or donors who were positive for hepatitis B surface antigen（HBsAg） or HBV DNA prior transplantation is obviously higher than the subjects with negative HBsAg or HBV DNA （P〈0.005）. ④Presence of HBsAg or HBV DNA prior transplantation provide no prognostic information. ⑤One patient receiving allogenic HSCT had both HBV and hepatitis E at day-41, and died of GVHD and liver failure. Conclusion Patients with HBsAg or HBV DNA before HSCT are at high risk of having hepatitis B after HSCT. Presence of HBsAg and HBV DNA had no effect on the survival of the patient after hematopoietic stem cell transplantation. Special attention should be paid for the infection by other hepatitis viruses.