文档介绍：1 肝移植术后乙型肝炎病毒再感染的预防与诊治作者: 夏杰杨占宇陈佳廖睿张南郭鹏周吉军王宇明【摘要】目的探讨肝移植术后 HBV 再感染的预防与诊治。方法回顾性分析 1999 年8 月至 2004 年 12月 98 例肝移植患者临床资料。其中 40 例术后采用拉米夫定(lamivudine,LAM) 单用方案预防 HBV 再感染, 58 例采用 LAM +乙型肝炎免疫球蛋白(HBIg) 联用方案。对 HBV 再感染者予以阿德福韦(adefovir,ADV) 抗病毒治疗。结果 17例肝移植患者出现 HBV 再感染,其中 14 例明确存在 YMD D 变异。术前血清 HBV DNA 阳性者术后 2年 HBV 再感染率显著高于阴性者(P< ) ,前者术后采用 LAM + HBIg 联合预防者其 HBV 再感染率显著低于单用 LAM 预防者(P< ) ,而后者术后 LAM 单用和 LAM + HBIg 联用两组之间差异无统计学意义(P> ) 。 15例 HBV 再感染者改用 AD V 治疗后, 13例(%) 于治疗后 1~3 个月 HBV DNA 转阴。结论术前降低血清 HBV DN A 水平和术后 LAM + HBI g 联合 2 预防方案能有效降低肝移植术后 HBV 再感染率。对术前 HBV DNA 阴性者,术后可选用 LAM 单药预防方案。 AD V 能够有效地治疗肝移植术后 HBV 再感染, 抑制 HBV 变异株的复制。【关键词】肝移植; 乙型肝炎病毒再感染; 乙型肝炎免疫球蛋白 Prevention and treatment of HBV rEinfection after liver transplantation 【 Abstract 】 Objective To study the prevention and treatment of HBV rEInfection after liver transplantation. Methods A retrospective study was carried out on 98 patients who received orthotopic liver transplantation (OLT) from August 1999 to December 2004. Fifty 拟 two patients were HBV DNA 拟 positive and 46 HBV DNA 拟 negative. All patients were divided into 4 groups: Group A[ HBV DNA 拟 positive patients treated by lamivudine (LAM), n=21 ], Group B (HBV DNA 拟 negative patients treated by LAM, n=19), Group C[ HBV DNA 拟 positive patients treated by LAM+ Hepatis B immunoglobulin (HBIG), n=31 ] and Group D (HBV DNA 拟 negative patients 3 treated by LAM+HBIG, n=27). Adefovir dipivoxil (ADV) was administered to those patients who developed LAM 拟 resistant HBV reinfection (YMDD). Results Of all, 17 patients developed HBV reinfection after OLT but 14 of them were identified to be LAM 拟 resistant HBV reinfection. The 2拟 year HBV reinfection rate was higher in HBV DNA 拟 positive patients than HBV DNA 拟 negative ones (). The 2拟 year reinfection rate in Group C was significantly lower than that in Group A (), while it showed no statistical difference between Group B and D. Fifteen HBV reinfection patients were given ADV treatment and HBV DNA negat