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目的探究肝移植术后乙型肝炎病毒(HBV)感染的影响因素。方法对1998年12月至2002年1月天津市第一中心医院92例HBV感染肝移植患者采用免疫抑制剂和抗生素预防感染等治疗,术后分为单独使用拉米夫定20例和乙型肝炎免疫球蛋白(HBIG)与拉米夫定联合应用72例两组。观察术后肝功能、HBV血清标记物、外周血单个核细胞(PBMC)中HBV DNA、YMDD及HBVS区基因变异、肝组织免疫组化等变化。结果HBV相关肝病肝移植患者乙型肝炎复发率为4.35%(4/92)。单用组HBV感染率为35%(7/20),联合治疗组HBV感染率为6.94%(5/72)。术前HBV DNA阴性者HBV感染率为0;术前HBV DNA阳性者,术后HBV感染率为17.39%(12/69),其中9例发生YMDD或S区基因变异。测定14例患者PBMC中HBV DNA,术前术后HBV DNA均阴性患者,HBV再感染率为11.11%(1/9);术前5例HBV DNA阳性者,术后HBV感染率为80%(4/5);术前术后HBV DNA均阳性者,术后HBV感染率100%(3/3);术前HBV DNA阳性而术后阴性者HBV感染率为50%(1/2)。结论单用拉米夫定预防肝移植术后HBV感染,较HBIG联合拉米夫定组容易造成HBV再感染。术前血清HBV DNA阳性、术前术后YMDD和S区基因变异以及PBMC中HBV DNA阳性是影响术后HBV再感染感染的主要因素。
Objective To explore the influencing factors of hepatitis B virus (HBV) infection after liver transplantation. Methods From December 1998 to January 2002, 92 patients with HBV-infected liver transplantation in the First Central Hospital of Tianjin were treated with immunosuppressive agents and antibiotics to prevent infection. After operation, they were divided into 20 cases of lamivudine alone and 2 cases of type B Hepatitis immunoglobulin (HBIG) combined with lamivudine 72 cases of two groups. The liver function, HBV serum markers, HBV DNA, YMDD and HBVS gene mutations in peripheral blood mononuclear cells (PBMCs) and the changes of liver tissue were observed. Results The recurrence rate of hepatitis B in patients with HBV-related liver disease was 4.35% (4/92). HBV infection rate was 35% (7/20) in combination group and 6.94% (5/72) in combination group. The HBV infection rate of preoperative HBV DNA negative was 0; HBV DNA positive preoperative HBV infection rate was 17.39% (12/69), of which 9 cases of YMDD or S gene mutation occurred. The HBV re-infection rate was 11.11% (1/9) in 14 patients with HBV DNA in PBMC and in patients with negative HBV DNA before and after surgery. HBV DNA was detected in 5 preoperative HBV DNA positive patients (80% 4/5). HBV DNA positive rate was 100% (3/3) after preoperative and postoperative HBV DNA test. The HBV DNA positive rate was 50% (1/2) after operation. Conclusions Monotherapy with lamivudine can prevent HBV infection after liver transplantation and cause HBV re-infection more easily than HBIG combined with lamivudine. Preoperative serum HBV DNA, preoperative and postoperative YMDD and S gene mutation and HBV DNA positive in PBMC are the main factors affecting postoperative infection with HBV.