CAJ | 학술논문

目的总结肝移植术后新发乙型肝炎病毒(HBV)感染的临床特点,探讨其防治策略.方法回顾分析2000年1月至2010年12月间接受肝移植的受者及术后新发HBV感染受者的临床资料.结果术前乙型肝炎表面抗原(HBsAg)阴性者365例,其中11例术后新发HBV感染,发生率为3.0％(11/365),多数受者无任何临床症状,仅在术后复查时发现HBsAg阳性,而肝功能正常.11例受者术后发现HBsAg阳性及HBV DNA处于复制状态后,均给予抗病毒治疗,1例原发病为丙型肝炎后肝硬化合并原发性肝癌的受者给予长效干扰素治疗,随后HBV DNA出现变异株,改用恩替卡韦治疗,其余10例受者均采用核苷类似物药物进行抗病毒治疗.有10例受者在术中应用了乙型肝炎免疫球蛋白(HBIG).经抗HBV治疗后,1例治疗无效进展为急性肝功能衰竭而死亡,1例因肿瘤复发转移而死亡,其余9例均存活.存活的9例受者中,1例出现乙型肝炎e抗原(HBeAg)转阴,4例HBV DNA复制水平为阴性(＜1×l05拷贝/L),所有存活受者的肝功能均正常.结论对于术前HBsAg阴性的受者在接受肝移植时,应严格筛查其所输注的血液制品；对于术前HBsAg阴性,且接受了乙型肝炎核心抗体和(或)HBV DNA阳性供肝的高危受者,术中及术后应常规使用HBIG及核苷类似物进行必要的抗乙肝治疗是预防术后新发HBV感染较为理想的策略,预后较好.
목적 총결간이식술후신발을형간염병독(HBV)감염적림상특점,탐토기방치책략.방법 회고분석2000년1월지2010년12월간접수간이식적수자급술후신발HBV감염수자적림상자료.결과 술전을형간염표면항원(HBsAg)음성자365례,기중11례술후신발HBV감염,발생솔위3.0％(11/365),다수수자무임하림상증상,부재술후복사시발현HBsAg양성,이간공능정상.11례수자술후발현HBsAg양성급HBV DNA처우복제상태후,균급여항병독치료,1례원발병위병형간염후간경화합병원발성간암적수자급여장효간우소치료,수후HBV DNA출현변이주,개용은체잡위치료,기여10례수자균채용핵감유사물약물진행항병독치료.유10례수자재술중응용료을형간염면역구단백(HBIG).경항HBV치료후,1례치료무효진전위급성간공능쇠갈이사망,1례인종류복발전이이사망,기여9례균존활.존활적9례수자중,1례출현을형간염e항원(HBeAg)전음,4례HBV DNA복제수평위음성(＜1×l05고패/L),소유존활수자적간공능균정상.결론 대우술전HBsAg음성적수자재접수간이식시,응엄격사사기소수주적혈액제품；대우술전HBsAg음성,차접수료을형간염핵심항체화(혹)HBV DNA양성공간적고위수자,술중급술후응상규사용HBIG급핵감유사물진행필요적항을간치료시예방술후신발HBV감염교위이상적책략,예후교호.
Objective To summary clinical character of de novo hepatitis B virus infection after liver transplantation,and explore the strategy of prevention and treatment.Methods The clinical data of recipients undergoing liver transplantation and the recipients who developed de novo hepatitis B virus infection after liver transplantation between Jan. 2000 to Dec. 2010 were retrospectively analyzed.Results 365 patients who underwent liver transplantation were negative for serum HBsAg before liver transplantation.Among them,11patients were diagnosed as having de novo hepatitis B virus infection after liver transplantation,with the morbidity being 3.0 ％(11/365).Most recipients did not have any clinical presentation.They were just found HBsAg positive during the follow-up period.The liver functions were normal.All 11patients received anti-virus therapy after they were found having positive HBsAg and replicated HBV-DNA.One patient whose primary disease was hepatitis C combined with primary hepatic carcinoma was treated with pegylated interferon,thereafter,he was found having YMDD-mutation of HBV-DNA,and he was treated with entecavir.The rest 10 patients received anti-virus treatment with nucleoside analog.The 10 recipients were injected with hepatitis B immunoglobin during operation.After anti-HBV therapy,one patient died from acute liver failure because of inefficient treatment,and one patient died from tumor recurrence.The remaining nine patients survived:HBeAg of one patient became negative,and HBV-DNA replications of the four patients became negative (＜1×105 copies/L).The liver function of the patients who survived was normal.Conclusion For recipients who were HBsAg negative before liver transplantation,when they received liver transplantation,,they should be given strict screening of blood product for transfusion.The liver transplantation patient who is HBsAg negative in serum before liver transplantation,and whose donor is HBcAb positive in serum and/or HBV-DNA positive in serum,should be treated with HBIG and/or nucleoside analog during operation or after operation,as we said above is a ideal strategy to prevent de novo hepatitis B virus infection after liver transplantation.The prognosis of de novo hepatitis B virus infection after liver transplantation is mild.