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目的探讨乙肝相关性终末期肝病肝移植术后乙肝病毒再感染的防治。方法回顾性分析我院1999年10月到2007年10月肝移植109例乙肝相关性终末期肝病患者,移植后给予抗病毒预防乙型肝炎病毒再感染,拉米夫定治疗组50例、拉米夫定和乙肝免疫球蛋白(乙肝免疫球蛋白)联合治疗组59例,观察临床表现,血清HbsAg、血清HbeAg、血清HBV DNA及必要时肝穿刺免疫组织化学检测HbsAg等指标。结果109例接受了3个月～8年的抗病毒治疗随访。①拉米夫定治疗组50例,10例复发,复发率为20%,复发病例中2例分别于术后5个月、8个月死于乙肝复发爆发性肝炎;余8例给予阿德夫韦和乙肝免疫球蛋白后,肝功能好转,目前在随访中。②拉米夫定和乙肝免疫球蛋白联合治疗59例,2例复发,给予调整免疫抑制药后,肝功能好转。两组比较差异有统计学意义(χ2=7.622,P<0.05)。结论用拉米夫定和乙肝免疫球蛋白联合应用可以有效预防肝移植后乙型肝炎病毒的再感染。
Objective To investigate the prevention and cure of hepatitis B virus re-infection after liver transplantation for hepatitis B-related end-stage liver disease. Methods A retrospective analysis of our hospital from October 1999 to October 2007 in 109 cases of liver transplantation in patients with hepatitis B-related end-stage liver disease, after transplantation given antiviral hepatitis B virus reinfection, 50 cases of lamivudine treatment group, pull Mifepristone and hepatitis B immunoglobulin (hepatitis B immunoglobulin) combined treatment group of 59 patients with clinical manifestations, serum HBsAg, serum HBeAg, serum HBV DNA and, if necessary, liver biopsy immunohistochemical detection of HbsAg and other indicators. Results 109 cases received 3 months to 8 years of antiviral treatment follow-up. ① lamivudine treatment group 50 cases, 10 cases of recurrence, the recurrence rate was 20%, 2 cases of recurrent cases were 5 months after surgery, 8 months died of recurrent hepatitis B hepatitis B; the remaining 8 cases were given Ade Fu Wei and hepatitis B immunoglobulin, liver function improved, at the current follow-up. ② lamivudine and hepatitis B immunoglobulin combined treatment of 59 cases, 2 cases of recurrence, after adjustment for immunosuppressive drugs, liver function improved. The difference between the two groups was statistically significant (χ2 = 7.622, P <0.05). Conclusion The combined use of lamivudine and hepatitis B immunoglobulin can effectively prevent the re-infection of hepatitis B virus after liver transplantation.