摘要
目的 探讨拉米夫定在预防肝移植术后乙型肝炎病毒 (HBV)再感染中的作用。方法 4 0例HBV相关疾病患者肝移植术后常规采用拉米夫定预防HBV再感染 ,同时监测乙型肝炎血清标记物、血清HBV DNA、YMDD区变异、肝活检组织乙型肝炎标记物免疫组化。结果 肝移植术后拉米夫定单一预防用药 6个月HBV再感染率为 12 .2 % ,12个月再感染率为 2 3.5 %。 4例患者HBV DNA转阳性 ,其中 3例YMDD区产生变异。术前HBVDNA阳性的患者在肝移植术后HBV再感染率高 ;而患者术前HBeAg的状态与肝移植术后HBV再感染无明显相关。结论 拉米夫定可以有效地预防肝移植术后HBV再感染 ;在拉米夫定用药的基础上HBV再感染可以产生YMDD区变异 ;HBV相关疾病患者行肝移植时术前应使HBVDNA转阴性。
Objective To discuss the effect of lamivudine as prophylaxis against hepatitis B virus(HBV) reinfection following orthotopic liver transplantation(OLT). Methods 40 patients with HBV related diseases received lamivudine, 100 mg/day, as prophylaxis against HBV reinfection after OLT. Hepatitis B serum markers, HBsAg, HBeAg, HBcAb IgM, and HBcAg were detected every 2 weeks by immunohistochenmistry. Serum HBV DNA was examined by PCR every 2 weeks. Liver biopy was conducted to the donor livers during operation and to the transplanted livers postoperatively in regular interval. HBsAg and HBcAg in the liver specimens were examined by immunohistochemistry. YMDD mutation sequencing was done to those patients with conversion of positive HBV DNA postoperatively. Results The positive rates were 100%, 25%, and 30% for the serum HBsAg, HBeAg, and HBV DNA of the patients respectively before OLT. All 40 donor liver specimens showed negative HBsAg and HBcAg. HBV reinfection rates were 12.2% and 23.5% 6 months and 12 months after OLT respectively. HBeAg had been positive in 4 out of the 6 cases with postoperative reinfection and had been positive in 8 out of the 34 cases without reinfection ( P =0.450 5). HBV DNA had been positive in 5 out of the 6 cases with postoperative reinfection, and had been positive in 7 out of the 34 cases without reinfection ( P =0.046 1). After OLT HBV DNA converted to positive in 4 cases, mutation of YMDD locus (YMDD YIDD) had been found in 3 of which. Conclusion Lamivudine monotherapy is effective against HBV reinfection after OLT. Given the lamivudine monotherapy, HBV reinfection causes mutation in YMDD locus on the HBV DNA polymerase gene. OLT does not apply in patients with positive HBV DNA. For those patients to be operated upon, lamivudine should be used to convert HBV DNA to negative beforehand.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2002年第7期445-448,共4页
National Medical Journal of China
