实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2015年
4期
209-214
,共6页
郑卫萍%沈中阳%郑虹%邓永林%潘澄%刘懿禾%宋红丽%张雅敏%蒋文涛%高伟
鄭衛萍%瀋中暘%鄭虹%鄧永林%潘澄%劉懿禾%宋紅麗%張雅敏%蔣文濤%高偉
정위평%침중양%정홍%산영림%반징%류의화%송홍려%장아민%장문도%고위
肝移植%乙型肝炎%复发%预防
肝移植%乙型肝炎%複髮%預防
간이식%을형간염%복발%예방
Liver transplantation%Hepatitis B%Recurrence%Prophylaxis
目的:比较单中心不同年代预防肝移植术后乙型肝炎(乙肝)复发治疗方案的临床效果,总结、优化治疗方案。方法选择天津市第一中心医院器官移植中心1994年5月至2012年12月因乙肝相关良性肝病接受首次肝移植术的984例成年患者,剔除围手术期(术后30天内)死亡者62例。依据患者术后预防乙肝复发治疗方案分为未治疗组、泛昔洛韦组、拉米夫定组和核苷(酸)类似物+乙肝免疫球蛋白(HBIG)组。结果922例患者中共有27例肝移植术后出现乙肝复发,其中3例肝移植术后未接受任何预防乙肝复发治疗的患者,均出现了乙肝复发,手术日期为1994~1999年间;术后接受泛昔洛韦治疗组患者2例,均出现乙肝复发,手术日期为1998至1999年间;单一应用拉米夫定组患者共15例,其中6例出现乙肝复发(40.0%),手术日期为1998至2001年间;1999年起接受核苷(酸)类似物+HBIG联合治疗组患者乙肝复发率为1.8%(16/902);四组患者间累积乙肝复发率差异有显著的统计学意义(χ2=48.99, P=0.000),累积存活率的差异也有显著的统计学意义(χ2=62.694,P=0.000)。结论伴随核苷(酸)类似物及HBIG的成功研制上市,我中心肝移植术后预防乙肝复发的治疗方案逐步得到优化完善,核苷(酸)类似物+HBIG联合治疗方案可有效预防肝移植术后乙肝复发,并已推广应用至全国,为肝移植术治疗乙肝相关终末期肝病提供有力保障。
目的:比較單中心不同年代預防肝移植術後乙型肝炎(乙肝)複髮治療方案的臨床效果,總結、優化治療方案。方法選擇天津市第一中心醫院器官移植中心1994年5月至2012年12月因乙肝相關良性肝病接受首次肝移植術的984例成年患者,剔除圍手術期(術後30天內)死亡者62例。依據患者術後預防乙肝複髮治療方案分為未治療組、汎昔洛韋組、拉米伕定組和覈苷(痠)類似物+乙肝免疫毬蛋白(HBIG)組。結果922例患者中共有27例肝移植術後齣現乙肝複髮,其中3例肝移植術後未接受任何預防乙肝複髮治療的患者,均齣現瞭乙肝複髮,手術日期為1994~1999年間;術後接受汎昔洛韋治療組患者2例,均齣現乙肝複髮,手術日期為1998至1999年間;單一應用拉米伕定組患者共15例,其中6例齣現乙肝複髮(40.0%),手術日期為1998至2001年間;1999年起接受覈苷(痠)類似物+HBIG聯閤治療組患者乙肝複髮率為1.8%(16/902);四組患者間纍積乙肝複髮率差異有顯著的統計學意義(χ2=48.99, P=0.000),纍積存活率的差異也有顯著的統計學意義(χ2=62.694,P=0.000)。結論伴隨覈苷(痠)類似物及HBIG的成功研製上市,我中心肝移植術後預防乙肝複髮的治療方案逐步得到優化完善,覈苷(痠)類似物+HBIG聯閤治療方案可有效預防肝移植術後乙肝複髮,併已推廣應用至全國,為肝移植術治療乙肝相關終末期肝病提供有力保障。
목적:비교단중심불동년대예방간이식술후을형간염(을간)복발치료방안적림상효과,총결、우화치료방안。방법선택천진시제일중심의원기관이식중심1994년5월지2012년12월인을간상관량성간병접수수차간이식술적984례성년환자,척제위수술기(술후30천내)사망자62례。의거환자술후예방을간복발치료방안분위미치료조、범석락위조、랍미부정조화핵감(산)유사물+을간면역구단백(HBIG)조。결과922례환자중공유27례간이식술후출현을간복발,기중3례간이식술후미접수임하예방을간복발치료적환자,균출현료을간복발,수술일기위1994~1999년간;술후접수범석락위치료조환자2례,균출현을간복발,수술일기위1998지1999년간;단일응용랍미부정조환자공15례,기중6례출현을간복발(40.0%),수술일기위1998지2001년간;1999년기접수핵감(산)유사물+HBIG연합치료조환자을간복발솔위1.8%(16/902);사조환자간루적을간복발솔차이유현저적통계학의의(χ2=48.99, P=0.000),루적존활솔적차이야유현저적통계학의의(χ2=62.694,P=0.000)。결론반수핵감(산)유사물급HBIG적성공연제상시,아중심간이식술후예방을간복발적치료방안축보득도우화완선,핵감(산)유사물+HBIG연합치료방안가유효예방간이식술후을간복발,병이추엄응용지전국,위간이식술치료을간상관종말기간병제공유력보장。
Objective To compare the clinical effects of different regimens for prophylaxis of hepatitis B recurrence post liver transplantation in different times of a single center,summarize and optimize the treatment protocol. Methods Nine hundred and eighty-four adult patients diagnosed as hepatitis B related end stage benign liver diseases underwent primary liver transplant between May 1994 and December 2012,of whom 62 recipients died within 30 days after transplantation and were not included for statistical analysis. The remaining 922 patients were grouped as non-treatment,famciclovir,lamivudine and nucleos(t)ide analogues combined with hepatitis B immune globulin(HBIG)group based on 4 different regimens for prophylaxis of hepatitis B recurrence post liver transplantation. Results Hepatitis B recurrence occurred in 27 patients. Among them,all the 3 patients of non-treatment group(underwent transplant between 1994-1999)showed recurrence,all the 2 patients in famciclovir group (underwent transplant between 1998-1999)showed recurrence,6 patients(40.0%)in lamivudine group(underwent transplant between 1998-2001)showed recurrence,and 16 patients(1.8%)in nucleos(t)ide analogues combined with HBIG group(underwent transplant between 1999-2012)showed recurrence. Both cumulative hepatitis B recurrence rates (χ2=48.99,P=0.000) and cumulative patient survival rates (χ2=62.694,P=0.000) showed significant statistical significance among these four groups of patients. Conclusion With the successful development and widespread marketing of nucleos(t)ide analogues and HBIG,regimens for prophylaxis of hepatitis B recurrence after liver transplantation have been optimized gradually in our center. Nucleos(t)ide analogues combined with HBIG was proved effective,and has been applicated by many other centers throughout our whole country,which provides strong support for the outcomes of liver transplantation in HBV-related end stage liver diseases.