中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (18): 3258-3261.doi: 10.3969/j.issn.1673-8225.2010.18.007

• 肝移植 liver transplantation • 上一篇    下一篇

乙型肝炎相关性终末期肝移植后乙型肝炎复发19例：
同一治疗机构43个月资料回顾

俞如胜，江  艺，吕立志，蔡秋程   

  1. 福建医科大学福总临床医学院肝胆外科，福建省福州市  350025
  • 出版日期:2010-04-30 发布日期:2010-04-30
  • 通讯作者: Jiang Yi, Doctoral supervisor, Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Clinical Medical College of Fujian Medical University, Fuzhou 350025, Fujian Province, China jiangyi183@yahoo.com.cn
  • 作者简介:俞如胜★，男，1975年生，福建省长汀县人，汉族，硕士，医师，主要从事肝移植方面的研究。
  • 基金资助:

    南京军区十一五计划重点课题(06Z46)。

Hepatitis B virus recurrence following liver transplantation: A 19-case report in the same treatment center within 43 months

Yu Ru-sheng, Jiang Yi, Lü Li-zhi, Cai Qiu-cheng   

  1. Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Clinical Medical College of Fujian Medical University, Fuzhou   350025, Fujian Province, China
  • Online:2010-04-30 Published:2010-04-30
  • Contact: 江 艺，博士生导师，福建医科大学福总临床医学院肝胆外科，福建省福州市 350025。 jiangyi183@yahoo.com.cn
  • About author:Yu Ru-sheng★, Master, Physician, Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Clinical Medical College of Fujian Medical University, Fuzhou 350025, Fujian Province, China
  • Supported by:

     the Eleventh Five-Year Plan Project of Nanjing Military Area Command of Chinese PLA, No. 06Z46*

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摘要：

背景：目前，肝移植后乙型肝炎复发的治疗效果欠佳，有关肝移植受者乙型肝炎复发后的抗病毒治疗经验及研究，国内外较少报道。
目的：应用阿德福韦酯+拉米夫定+乙型肝炎免疫球蛋白抗病毒治疗方案，探讨肝移植后乙型肝炎病毒复发的抗病毒治疗效果及肝功能改善情况。
方法：回顾性分析了2005-01/2008-10于解放军南京军区福州总院肝移植中心行肝移植治疗的208例乙型肝炎相关终末期肝病患者。所有患者肝移植后给予拉米夫定+乙型肝炎免疫球蛋白预防乙型肝炎病毒复发，术后随访6~43个月，共有19例复发，其中乙型肝炎病毒e抗原阳性13例，明确有YMDD变异8例。19例复发患者均在原有的抗病毒治疗方案基础上加用阿德福韦酯治疗。
结果与结论：19 例乙型肝炎复发患者在治疗12，24，48周时，乙型肝炎病毒DNA、谷丙转氨酶与前次比较明显下降(P < 0.01)。治疗48周时谷丙转氨酶复常率、乙型肝炎病毒e抗原阴转率、乙型肝炎病毒DNA阴转率分别为84%，77%，79%。说明联合应用阿德福韦酯+拉米夫定+乙型肝炎免疫球蛋白抗病毒治疗能有效抑制乙型肝炎病毒复制，治疗肝移植后乙型肝炎复发。

关键词: 肝炎, 乙型, 乙型肝炎病毒, 阿德福韦酯, 复发, 治疗, 肝移植

Abstract:

BACKGROUND: Hepatitis B virus (HBV) recurrence following liver transplantation has been difficultly treated, and antiviral therapy following HBV recurrence has been less reported yet.
OBJECTIVE: To investigate the antiviral therapy using Adefovir + Lamivudine + anti-hepatis B immunoglobulin on liver functional improvement following liver transplantation.
METHODS: A total of 208 cases with hepatitis B-related end-stage liver disease following liver transplantation were selected from Liver Transplantation Center of Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January 2005 to October 2008. All patients were treated with Lamivudine + anti-hepatis B immunoglobulin so as to prevent from HBV recurrence. At 6-43 months after following up, HBV recurrence was found in 19 cases, including 13 with positive HBeAg and 8 with YMDD mutation. The 19 patients were treated with Adefovir based on the application of Lamivudine + anti-hepatis B immunoglobulin.
RESULTS AND CONCLUSION: At 12, 24, and 48 weeks after treatment, DNA and glutamic-pyruvic transaminase of 19 cases were significantly decreased (P < 0.01). After 48-week treatment, recovery rate of glutamic-pyruvic transaminase, negativity rate of HBeAg, and negativity rate of HBV DNA were 84.1%, 76.92%, and 78.9%, respectively. The results demonstrated that the application of Adefovir + Lamivudine + anti-hepatis B immunoglobulin effectively inhibited viral replication and prevented HBV recurrence following liver transplantation.