肝移植术后丙肝复发的临床分析

摘要 目的: 丙肝复发是很普遍的而且会导致5-10年内20-30%的患者进展为肝硬化，早期监测移植术后HCV复发的危险因素能够帮助医生进行抗病毒治疗。本文肝移植后丙肝复发患者的资料进行回顾性研究，对危险因素进行评价，以期丙肝的防治提供参考依据。方法: 收集2006年4月～2009年11月间在天津第一中心医进行同种异体肝移植术的丙肝患者资料加以分析总结，随访期大于3个月资料齐全者被纳入本次研究。共有患者44人，其中男性37人，女性7人，平均年龄57.84（39-76）岁，随访时间3-42月。检查术前及术后HCVRNA水平以及组织学和临床后果。常规给予FK506＋MMF＋Pred三联或无激素二联免疫抑制药物，于术后定期检测患者的肝功能、免疫抑制剂（FK506）血药浓度、HCVRNA水平，分析肝移植术后丙肝复发的的影响因素。结果: 肝移植术后丙肝复发患者有31例，复发率达70.46%。术前及术后早期HCVRNA>104丙肝复发率显著升高（P<.01）。年龄大于65岁复发率高于65岁以下患者(P<.05)。使用干扰素抗病毒治疗较未治疗患者病毒转阴率升高（P<.05）。合并巨细胞病毒感染以及免疫抑制剂的使用方案与复发无关。结论: 1. 肝移植术前及术后早期HCVRNA复制水平是影响肝移植术后丙肝复发和预后的重要因素。2、肝移植术后使用干扰素抗病毒治疗的疗效是肯定的。

Clinical Study of Recurrence Hepatitis C of Post Liver Transplantation

Abstract Objective：Recurrence of hepatitis C in the graft is universal and may lead to chronic hepatitis in most patients and to cirrhosis in 20-30% of patients within 5-10 years of transplantation. Early identification of patients at a higher risk of rapidly progressive recurrent hepatitis post liver transplantation (LT) could help to tailor antiviral therapy. We retrospective studied the risk factors of recurrence of hepatitis C in the graft and wish to provide basis for prevention and treament of hepatitis C. Methods：We studied the before and early post-LT viral load and the histological and clinical outcomes of 44 consecutive patients (37 males,7 female, median age 57.84（39-76） years) ,whom were receiving liver transplantation in tianjin first central hospital from 2006 4th to 2009 4th. The immunosuppressive therapy（FK506＋MMF＋Pred），examing the liver function，FK blood concentration，HCV viraemia are convention,analysis the impactive factors of hepatitis C recurrence. Results：Hepatitis C recurred at histology in 31 of 44 (70.46%) patients. Brfore LT and early viral load after LT was higher in patients with rapidly progressive hepatitis C recurrence (（P<.01）.Recipient older than 65 years have higher recurrent rate(P<.05). Antiviral therapy with interferon compared with untreated patients with higher HCV negative rate (P <.05). Cytomegalovirus infection and the use of immunosuppressive program has nothing to do with the recurrence Conclusion：The results emphasize the importance of high viral loads in the pre and early posttransplant period as an independent redictor of recipient outcomes. 2Interferon antiviral therapy is feasible for recurrence hepatitis C.