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本文报道了一例两次行肝移植至今存活的病人。用拉米夫定先后联合阿德福韦、乙型肝炎免疫球蛋白治疗,并检测乙型肝炎病毒(HBV)耐药时HBsAg亚型的变化。从而探讨HBV病毒亚型变异所致的耐药。在肝移植后抗病毒联合治疗,可能会降低HBV再感染的危险性。 患者首次肝移植后,感染HBV即用拉米夫定每日1次,每次100mg治疗,13个月后HBV DNA再次出现(5.2×10~6拷贝/毫升),ALT值升高至正常6倍。基因分析,发现HBV基因组P区变异,从而导致对拉米夫定耐药。 继续使用拉米夫定并联合阿德福韦,血清HBV DNA浓度降至1.2×10~4拷贝/毫升以后,病人发展为失代偿性肝硬化,经再次移植,持续使用阿德福韦15天(后因供药中断而停药)。第15天时,用PER(敏感度10~3拷贝/毫升)可检出HBV DNA,显示仍为对拉米夫定耐药基因。
This article reports an example of two patients who survived liver transplantation to date. With lamivudine has combined adefovir, hepatitis B immunoglobulin therapy, and detect hepatitis B virus (HBV) resistance HBsAg subtype changes. To explore the variation of HBV virus subtypes caused by resistance. Antiviral combination therapy after liver transplantation may reduce the risk of HBV re-infection. After the first liver transplant, HBV was treated with lamivudine once daily for 100 mg once. After 13 months HBV DNA reappeared (5.2 × 10 6 copies / ml) and the ALT increased to normal 6 Times Gene analysis found that HBV genome P region variation, leading to resistance to lamivudine. Continue to use lamivudine and adefovir, the serum HBV DNA concentration dropped to 1.2 × 10 ~ 4 copies / ml later, the patient developed decompensated cirrhosis, after another transplant, continuous use of adefovir 15 Days (after withdrawal due to drug withdrawal). On day 15, HBV DNA was detected with PER (sensitivity 10-3 copies / ml) and remained as resistant to lamivudine.