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目的评估肝移植术后长期联合应用拉米夫定(LAM)和小剂量乙肝免疫球蛋白(HBIG)预防乙型肝炎复发的疗效,探讨肝移植术后乙型肝炎病毒(HBV)再感染和乙型肝炎复发的长期联合预防方案。方法通过前瞻性研究中山大学附属第三医院肝脏移植中心1993年10月至2005年8月符合研究标准的190例肝移植,术后应用拉米夫定联合小剂量乙肝免疫球蛋白预防,出现LAM耐药时加用阿德福维(ADV)。依据乙肝病毒标志物、HBVDNA定量、YMDD变异、生化指标和组织病理学检查诊断HBV再感染和乙型肝炎复发。结果190例中出现再感染15例(7.9%),其中肝炎复发7例,加用ADV治疗好转5例,再移植2例;其余HBV再感染8例均加用ADV治疗,血清HBVDNA水平下降5例,转为阴性3例;HBsAg阴转1例。随访时间12～34个月,平均再感染时间8.3月。结论长期联合应用拉米夫定和小剂量乙肝免疫球蛋白可有效预防乙型肝炎复发,加用阿德福维可有效治疗拉米夫定耐药。
Objective To evaluate the efficacy of long-term combined use of lamivudine (LAM) and low-dose hepatitis B immunoglobulin (HBIG) in the prevention of hepatitis B recurrence after liver transplantation and to investigate the effect of hepatitis B virus re-infection Long-term combined prevention of recurrent hepatitis. Methods A prospective study of 190 liver transplant recipients from the Third Affiliated Hospital of Sun Yat-sen University from October 1993 to August 2005 who met the criteria of the study was treated with lamivudine combined with low-dose hepatitis B immunoglobulin. LAM Add adefovir (ADV) when resistant. HBV re-infection and hepatitis B recurrence were diagnosed on the basis of HBV markers, HBVDNA quantification, YMDD mutation, biochemical markers and histopathological examination. Results Among the 190 cases, 15 cases (7.9%) were re-infected, including 7 cases of recurrent hepatitis, 5 cases treated with ADV and 2 cases transplanted again. All 8 cases were re-infected with ADV, and the serum HBV DNA levels were decreased by 5 Cases, turned negative in 3 cases; HBsAg negative in 1 case. Follow-up time of 12 to 34 months, the average time of infection 8.3 months. Conclusion Long-term combined use of lamivudine and low-dose hepatitis B immunoglobulin can effectively prevent the recurrence of hepatitis B. Adefovir can be used to treat lamivudine effectively.