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目的探讨拉米夫定联合低剂量乙型肝炎(乙肝)免疫球蛋白(HBIG)预防肝移植术后乙肝复发的效果及乙肝复发后的治疗。方法对2000年12月至2003年5月因乙肝相关性终末期肝病和(或)合并肝细胞癌于我院接受肝移植手术并经随访的11例患者进行回顾性分析。所有患者均接受拉米夫定联合低剂量HBIG预防乙肝复发方案。观察术后近期乙肝转阴情况、术后较远期乙肝复发情况以及乙肝复发后的治疗情况。结果(1)所有患者HBsAg、HBeAg、HBV-DNA均于术后1~4d转为阴性,术后1周所有患者对HBIG均有反应,HBsAb滴度水平逐渐上升;(2)所有患者于观察期内生存情况均良好,对患者HBsAb滴度水平定期进行监测结果示大部分患者HBsAb滴度水平与预期治疗水平基本符合;(3)1例患者于术后25个月乙肝复发,通过改用阿德弗韦并加大HBIG用量,基本得到控制。结论拉米夫定联合低剂量HBIG预防肝移植后乙肝复发疗效确切,而且可显著降低治疗费用。
Objective To investigate the effect of lamivudine combined with low dose hepatitis B (HBIG) in preventing hepatitis B recurrence after liver transplantation and the treatment after hepatitis B recurrence. Methods Retrospective analysis was performed on 11 patients who underwent liver transplantation and were followed up in our hospital from December 2000 to May 2003 due to hepatitis B-related terminal liver disease and / or hepatocellular carcinoma. All patients received lamivudine combined with low-dose HBIG to prevent recurrent hepatitis B regimen. To observe the recent postoperative hepatitis B negative conditions, postoperative recurrence of hepatitis B and the treatment of hepatitis B after relapse. Results (1) HBsAg, HBeAg and HBV-DNA in all patients turned negative 1 to 4 days after operation. All patients responded to HBIG one week after operation, and the level of HBsAb titer increased gradually. (2) All patients were observed Survival was good during the period. The regular monitoring of HBsAb titers in patients showed that the HBsAb titers in most of the patients were basically consistent with the expected treatment level. (3) One patient had recurrent hepatitis B at 25 months after operation, Adefove and increase the amount of HBIG, the basic control. Conclusion Lamivudine combined with low-dose HBIG can effectively prevent hepatitis B recurrence after liver transplantation, and can significantly reduce the cost of treatment.