目的探索乙型肝炎DNA阳性的终末期肝病患者肝移植前快速转阴及肝移植术后复发的防治。方法4例乙型肝炎两对半小三阳、HBVDNA(-)的患者术前开始联合口服拉米夫定(lamivudine) 及泛昔洛韦, 术后3个月内治疗同前, 3个月后仅口服拉米夫定维持至今; 2例乙型肝炎两对半大三阳、HBVDNA(+)的患者, 术前除口服拉米夫定及泛昔洛韦外, 同时肌注乙肝免疫球蛋白共14 d,肝移植术中无肝期快速静脉滴注15 000 u静脉用乙肝免疫球蛋白,术后3个月内联合口服拉米夫定及泛昔洛韦, 术后3个月内治疗同前, 3个月后仅口服拉米夫定维持至今。结果1例患者术后第19天死于肺部霉菌感染,1例患者第49天死于肝动脉及门静脉栓塞; 4例患者长期存活, 生存时间最长的患者已接近3年,术后全部患者均未发现有乙型肝炎复发。结论拉米夫定、乙肝免疫球蛋白及泛昔洛韦联合使用可使乙型肝炎DNA阳性的终末期肝病患者在肝移植前快速转阴,并能预防乙肝复发。
Citation:
冉江华,李立,张炳彦,张捷,李晓延,唐继红,黄明,孙锋,李文,阿永俊,田大广. Prevention for Recurrence of Patients with Hepatitis B after Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(5): 496-497. doi:
Copy
1. |
Todo S, Demetris AJ, Van Thiel D, et al. Orthotopic liver transplantation for patients with hepatitis B virusrelated liver disease [J]. Hepatology, 1991; 13(4)∶619.
|
2. |
Secerini A, Liu XY, Wilson JS, et al. Mechanism of inhibition of duck hepatitis B virus polymerase by (-)betaL2’, 3’dideoxy3’thiacytidine [J]. Antimicrob Agents Chemother, 1995; 39(7)∶1430.
|
3. |
陈长宏, 董家鸿, 王曙光, 等. 拉咪呋啶预防肝移植术后乙型肝炎病毒再感染的研究 [J] . 解放军医学杂志, 2001; 26(7)∶531.
|
4. |
Perrillo R, Rakela J, Martin P, et al. Lamivudine for hepatitis B after liver transplantation (Abstract) [J]. Hepatology, 1996; 24(4 Pt 2)∶182A.
|
5. |
杨翔, 邱繁荣, 贺强, 等. 乙型肝炎后肝硬变终末期行肝移植术的可行性探讨 [J]. 山西医药杂志, 2000; 29(10)∶376.
|
6. |
朱晓峰, 陈规划, 何晓顺, 等.原位肝移植治疗急性重型肝炎 [J] . 中华器官移植杂志, 2000; 21(3)∶173.
|
7. |
Ghany MG, Ayola B, Villamil FG, et al. Hepatitis B virus S mutants in liver transplant recipients who were reinfected despite hepatitis B immune globulin prophylaxis [J]. Hepatology, 1998; 27(1)∶213.
|
- 1. Todo S, Demetris AJ, Van Thiel D, et al. Orthotopic liver transplantation for patients with hepatitis B virusrelated liver disease [J]. Hepatology, 1991; 13(4)∶619.
- 2. Secerini A, Liu XY, Wilson JS, et al. Mechanism of inhibition of duck hepatitis B virus polymerase by (-)betaL2’, 3’dideoxy3’thiacytidine [J]. Antimicrob Agents Chemother, 1995; 39(7)∶1430.
- 3. 陈长宏, 董家鸿, 王曙光, 等. 拉咪呋啶预防肝移植术后乙型肝炎病毒再感染的研究 [J] . 解放军医学杂志, 2001; 26(7)∶531.
- 4. Perrillo R, Rakela J, Martin P, et al. Lamivudine for hepatitis B after liver transplantation (Abstract) [J]. Hepatology, 1996; 24(4 Pt 2)∶182A.
- 5. 杨翔, 邱繁荣, 贺强, 等. 乙型肝炎后肝硬变终末期行肝移植术的可行性探讨 [J]. 山西医药杂志, 2000; 29(10)∶376.
- 6. 朱晓峰, 陈规划, 何晓顺, 等.原位肝移植治疗急性重型肝炎 [J] . 中华器官移植杂志, 2000; 21(3)∶173.
- 7. Ghany MG, Ayola B, Villamil FG, et al. Hepatitis B virus S mutants in liver transplant recipients who were reinfected despite hepatitis B immune globulin prophylaxis [J]. Hepatology, 1998; 27(1)∶213.