CAJ | 학술논문

目的：了解非乙型肝炎相关性肝移植术后患者新发 HBV 感染的发生率、危险因素、临床特点及转归。方法随访单中心非乙型肝炎相关性肝移植术后患者97例，在肝移植术前及术后随访期间规律记录患者的肝功能、乙型肝炎病毒标志物、HBV DNA 定量及相关用药等情况。结果97例患者的供体均 HBsAg 阴性，平均随访54个月（6～112个月），15例出现 HBsAg 阳性（15．46％），受体抗-HBc 阴性是术后新发乙型肝炎的危险因素（RR ＝4．62），抗-HBs／抗-HBc双阳性是术后新发乙型肝炎的保护因素（RR＝5．16），而低水平抗-HBs 阳性并不能防止术后新发乙型肝炎（RR ＝1．32）。15例新发乙型肝炎时间为肝移植术后2～47个月（中位时间8个月），13例（86．67％）同时出现 HBV DNA 阳性，7例（46．67％）出现生物化学异常（均为 HBV DNA 阳性）。经核苷类似物治疗11例（73．33％）发生 HBsAg 血清学转换，但1例停药后 HBsAg 复阳，5例持续 HBsAg 阳性，慢性化率为33．33％，高于非移植人群。结论非乙型肝炎相关性肝移植术后存在新发乙型肝炎的风险，慢性化率高于非移植人群，应规范预防措施。
목적：료해비을형간염상관성간이식술후환자신발 HBV 감염적발생솔、위험인소、림상특점급전귀。방법수방단중심비을형간염상관성간이식술후환자97례，재간이식술전급술후수방기간규률기록환자적간공능、을형간염병독표지물、HBV DNA 정량급상관용약등정황。결과97례환자적공체균 HBsAg 음성，평균수방54개월（6～112개월），15례출현 HBsAg 양성（15．46％），수체항-HBc 음성시술후신발을형간염적위험인소（RR ＝4．62），항-HBs／항-HBc쌍양성시술후신발을형간염적보호인소（RR＝5．16），이저수평항-HBs 양성병불능방지술후신발을형간염（RR ＝1．32）。15례신발을형간염시간위간이식술후2～47개월（중위시간8개월），13례（86．67％）동시출현 HBV DNA 양성，7례（46．67％）출현생물화학이상（균위 HBV DNA 양성）。경핵감유사물치료11례（73．33％）발생 HBsAg 혈청학전환，단1례정약후 HBsAg 복양，5례지속 HBsAg 양성，만성화솔위33．33％，고우비이식인군。결론비을형간염상관성간이식술후존재신발을형간염적풍험，만성화솔고우비이식인군，응규범예방조시。
Objective To investigate the incidence,risk factors,clinical features,and outcomes of de novo hepatitis B virus (HBV)infection after liver transplantation (LT)in hepatitis B surface antigen (HBsAg)negative recipients.Methods Ninety-seven HBsAg-negative patients underwent LT in a single LT center from 2006-2014 were enrolled,whose liver function,HBV markers,HBV DNA quantity and medications were regularly detected from preoperative to postoperative. Results De novo HBV infection occurred in 15 of 97 HBsAg-negative patients (15.46%)after LT during an average 54-month (6-112 months)follow-up.Hepatitis B core antibody (HBcAb)negative was a risk factor for de novo hepatitis B after LT (RR=4.62),while hepatitis B surface antibody (HBsAb)/HBcAb double positive was a protective factor (RR =5.16).However,low titer of HBsAb had no protection from de novo hepatitis B (RR = 1 .32).Fifteen recipients were detected as HBsAg positive at the time point of 2-47 months after LT (median time 8 months).Moreover,13 of the 15 cases (86.67%)were measured as HBV DNA positive at the same time with HBV DNA loading ranging from 1 .210×102 IU/L ~ 6.226×109 IU/L (average 7.046× 108 IU/L),and 7 cases (46.67%)displayed abnormalization in liver enzymes. After treatment with nucleoside analogue (NA),11 of the 15 cases (73.33%)exhibited HBsAg seroconversion.Among these 11 cases,1 case showed recurred HBsAg positive again after NA was withdrawn.Five cases maintained HBsAg positive.Chronic rate was 33.33%,which was higher than that in non LT population (P <0.05).Conclusion Compared to those in non-LT populations,there was higher risk of de novo HBV infection and higher chronic rate in LT patients. Consequently,prophylaxis therapy should be carried out in clinical practice for LT patients.