CAJ | 학술논문

目的探讨乙型肝炎相关性肝移植患者术后在核苷(酸)类似物联合小剂量乙型肝炎免疫球蛋白的预防下乙型肝炎复发的危险因素及预后.方法253例乙型肝炎相关性肝移植患者术前即开始给予核苷(酸)类似物预防,术中和术后均给予核苷(酸)类似物联合乙型肝炎免疫球蛋白处理.结果在253例肝移植患者中,死亡29例(11.5%);术前基础病为HBV相关性肝癌患者的病死率为21.2%,显著高于非肝癌患者的5.2%(P=0.000);乙型肝炎复发16例(6.3%);复发后均停用乙型肝炎免疫球蛋白,并调整核苷(酸)类似物,结果患者HBV DNA均<500IU/ml,肝功能稳定;Log-rank检验显示乙型肝炎复发后及时治疗对患者生存无明显影响;经Logistic多因素回归分析表明,术前HBeAg阳性、HBV DNA≥105IU/ml、HCC和HBV/YMDD变异是乙型肝炎复发的危险因素.结论肝移植能够有效治疗乙型肝炎相关性终末期肝病,在核苷(酸)类似物联合乙型肝炎免疫球蛋白预防后,仍有乙型肝炎复发,其对生存率的影响有待于观察.
목적탐토을형간염상관성간이식환자술후재핵감(산)유사물연합소제량을형간염면역구단백적예방하을형간염복발적위험인소급예후.방법253례을형간염상관성간이식환자술전즉개시급여핵감(산)유사물예방,술중화술후균급여핵감(산)유사물연합을형간염면역구단백처리.결과재253례간이식환자중,사망29례(11.5%);술전기출병위HBV상관성간암환자적병사솔위21.2%,현저고우비간암환자적5.2%(P=0.000);을형간염복발16례(6.3%);복발후균정용을형간염면역구단백,병조정핵감(산)유사물,결과환자HBV DNA균<500IU/ml,간공능은정;Log-rank검험현시을형간염복발후급시치료대환자생존무명현영향;경Logistic다인소회귀분석표명,술전HBeAg양성、HBV DNA≥105IU/ml、HCC화HBV/YMDD변이시을형간염복발적위험인소.결론간이식능구유효치료을형간염상관성종말기간병,재핵감(산)유사물연합을형간염면역구단백예방후,잉유을형간염복발,기대생존솔적영향유대우관찰.
Objective To investigate the risk factors and prognosis of hepatitis B recurrence in patients with hepatitis B virus (HBV)related orthotopic liver transplantation (OLT)under the prophylaxis of combined low-dose hepatitis B immunoglobulin(HBIG)and nucleot(s)ide analogues. Methods 253 patients had OLT for HBV-related liver disease in our medical department. All patients received nucleot (s)ide analogues and low-dose HBIG therapy after liver transplantation. Results 29 patients(11.5%)died in the follow-up after liver transplan-tation; The fatality rates in patients with underlying hepatocellular carcinoma (HCC)and non-HCC were 21.2%(21/99)and 5.2%,respectively(P=0.000);16 patients(6.3%)had hepatitis B recurrence;HBIG therapy in recurred patients was terminated and nucleot(s)ide analogues was modulated. All patients with hepatitis B recurrence had serum HBV DNA loss and liver function index returned to normal;Logistic regression analysis showed that risk factors for hepatitis B recurrence were HBeAg positive,high HBV DNA load,HCC and HBV/YMDD mutants