中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2009年
2期
106-109
,共4页
戴军%卢实春%严律南%李波%赖威%赵冀%金圣杰%文天夫%赵纪春%曾勇%陶传敏%张秀辉
戴軍%盧實春%嚴律南%李波%賴威%趙冀%金聖傑%文天伕%趙紀春%曾勇%陶傳敏%張秀輝
대군%로실춘%엄률남%리파%뢰위%조기%금골걸%문천부%조기춘%증용%도전민%장수휘
肝移植%乙肝标志物%再感染%复发
肝移植%乙肝標誌物%再感染%複髮
간이식%을간표지물%재감염%복발
Liver transplantation%HBV marker%Reinfection
目的 通过长期观察大三阳乙肝病人肝移植后在LAM或(和)HBIG预防下其体内HBV标志物的变化.探讨乙肝复发的可能机制,为预防复发及个体化治疗寻找切人点.方法 ELISA、HBV-DNA荧光定量、免疫组化定期检测术前术后各期血清及其供肝活检组织,回顾性观察55例大三阳病人随访中HBV标志物的变化.结果 平均随访69.14个月,共12例乙肝再感染/复发,LAM+HBIG组乙肝复发比率为4.8%(2/42),而LAM组为76.9%(10/13)(P=0.000).联合组1、2、3、4年生存率分别为100%、97.1%、92.7%、92.7%;单用组1、2、3、4年生存率分别为76.9%、69.2%、53.8%、46.2%(P=0.000);前者2年内乙肝复发率<3%,后者1、2、3、4年复发率分别为16.1%、41.3%、66.4%、66.4%(P=0.000).结论 HBIG联合核苷(酸)类似物作为当前最佳的乙肝复发预防方案明显地降低了复发率,治疗依从性差及病毒的自身状态是中国肝移植后乙肝再感染/复发的主要原因.根据治疗过程中病毒自身状态的变化及时调整用药将有助于进一步减少术后乙肝复发.
目的 通過長期觀察大三暘乙肝病人肝移植後在LAM或(和)HBIG預防下其體內HBV標誌物的變化.探討乙肝複髮的可能機製,為預防複髮及箇體化治療尋找切人點.方法 ELISA、HBV-DNA熒光定量、免疫組化定期檢測術前術後各期血清及其供肝活檢組織,迴顧性觀察55例大三暘病人隨訪中HBV標誌物的變化.結果 平均隨訪69.14箇月,共12例乙肝再感染/複髮,LAM+HBIG組乙肝複髮比率為4.8%(2/42),而LAM組為76.9%(10/13)(P=0.000).聯閤組1、2、3、4年生存率分彆為100%、97.1%、92.7%、92.7%;單用組1、2、3、4年生存率分彆為76.9%、69.2%、53.8%、46.2%(P=0.000);前者2年內乙肝複髮率<3%,後者1、2、3、4年複髮率分彆為16.1%、41.3%、66.4%、66.4%(P=0.000).結論 HBIG聯閤覈苷(痠)類似物作為噹前最佳的乙肝複髮預防方案明顯地降低瞭複髮率,治療依從性差及病毒的自身狀態是中國肝移植後乙肝再感染/複髮的主要原因.根據治療過程中病毒自身狀態的變化及時調整用藥將有助于進一步減少術後乙肝複髮.
목적 통과장기관찰대삼양을간병인간이식후재LAM혹(화)HBIG예방하기체내HBV표지물적변화.탐토을간복발적가능궤제,위예방복발급개체화치료심조절인점.방법 ELISA、HBV-DNA형광정량、면역조화정기검측술전술후각기혈청급기공간활검조직,회고성관찰55례대삼양병인수방중HBV표지물적변화.결과 평균수방69.14개월,공12례을간재감염/복발,LAM+HBIG조을간복발비솔위4.8%(2/42),이LAM조위76.9%(10/13)(P=0.000).연합조1、2、3、4년생존솔분별위100%、97.1%、92.7%、92.7%;단용조1、2、3、4년생존솔분별위76.9%、69.2%、53.8%、46.2%(P=0.000);전자2년내을간복발솔<3%,후자1、2、3、4년복발솔분별위16.1%、41.3%、66.4%、66.4%(P=0.000).결론 HBIG연합핵감(산)유사물작위당전최가적을간복발예방방안명현지강저료복발솔,치료의종성차급병독적자신상태시중국간이식후을간재감염/복발적주요원인.근거치료과정중병독자신상태적변화급시조정용약장유조우진일보감소술후을간복발.
Objective To investigate the long-term prophylactic outcome in recipients with HBV active replication under LAM or/and HBIG prophylaxis after liver transplantation. Methods The liver biopsy specimens and serum samples were collected during the follow-up. ELISA and chemiluminesent microparticle immunoassay, HBV-DNA fluorescent quantification, immunohisto-chemisty and HBV-DNA in situ hybridization were performed for analysis. The alteration of HBV markers in serial biopsy and sera of 55 recipients were investigated retrospectively. Results The mean time of follow-up was 69.14 months. Twelve cases had hepatitis B virus reinfection after transplanta-tion. The accumulated ratio of hepatitis B virus reinfection was 4.8%(2/42)in LAM+ HBIG group and 76.9%(10/13) in LAM monopropyhlaxis group (P=0.000). The 1-,2-,3- and 4-y survival rates in combined prophylaxis group were 100%, 97.1%, 92.7% and 92.7%, respectively. The 1-,2-,3- and 4-yr survival rates in LAM mono prophylaxis group were 76.9%, 69.2%, 53.8% and 46.2&, re-spectively (P=0.000). The rates of hepatitis B virus reinfection in combination prophylaxis group (1-,2-,3- and 4-yr recurrence rates of 2.4%, 2.4%, 2.4% and 8.5%, respectively) was markedly lower than those in mono prophylaxis group(1-, 2-, 3- and 4-yr recurrence rates of 16.1%, 41.3 %, 66.4% and 66.4%, respectively)(P=0.000). Conclusion Currently HBIG combined with LAM is an optimal prophylatic protocol to reduce the hepatitis B virus reinfection rate. However, poor compli-ance of recipients to a prescribed course of prophylaxis as well as viral status itself is still the main cause of hepatitis B virus reinfection after liver transplantation in China. Compliance education and ad-justing the prophyiatic protocols according to the viral alteration after liver transplantation may help to further decrease the hepatitis B virus reinfection rate.
