中国组织工程研究Issue(31)：5588-5594,7.DOI:10.3969/j.issn.2095-4344.2013.31.002
恩替卡韦联合人免疫球蛋白预防肝移植后乙肝复发★
Entecavir combined with immunoglobulin prevents hepatitis B recurrence after liver transplantation
高银杰 1刘振文 1张敏 1苏海滨 1周双男 1周霞 1张达利 1贺希 1汤汝佳1
作者信息
- 1. 解放军第三○二医院肝移植中心，北京市 100039
- 折叠
摘要
Abstract
BACKGROUND:Prolonged therapy with lamivudine has been associated with tyrosine-methionine-aspartate-aspartate mutation, which results in hepatitis B recurrence. Recently, antiviral agents, such as entecavir, have high efficacy and low resistance rate in hepatitis B-related liver disease. However, the researches on the effect of entecavir in preventing hepatitis B recurrence after liver transplantation are rare. OBJECTIVE:To investigate the effect of entecavir combined with low-dose hepatitis B immunoglobulin in preventing hepatitis B recurrence after liver transplantation. METHODS:The fol ow-up data of 253 patients who had liver transplantation for hepatitis B virus related liver disease were retrospectively analyzed. Al patients received nucleoside analogues therapy formal y before liver transplantation. The effects of entecavir+hepatitis B immunoglobulin and lamivudine+hepatitis B immunoglobulin were compared in al the patients and the patents with hepatitis B recurrence risk factors (positive preoperative HBeAg, DNA-positive hepatitis B virus, hepatoma and tyrosine-methionine-aspartate-aspartate mutation). RESULTS AND CONCLUSION:A total of 253 patients received hepatitis B virus-related liver transplantation, and 29 patients died. There were 202 patients in lamivudine group in which 26 patients were dead and 16 patients had hepatitis B virus recurrence, and the recurrence rate was 7.92%(16/202). However, entecavir group had 51 patients without hepatitis B virus recurrence in which three patients were dead. There were significant differences in the mortality rate and recurrence rate between two groups. Compared with the lamivudine+hepatitis B immunoglobulin, entecavir+hepatitis B immunoglobulin could effectively reduce the recurrence rate of the patients with hepatitis B virus-related risk factors. Hepatitis B immunoglobulin was terminated and nucleoside analogues were modulated when recurrence appeared. Al patients hepatitis B virus DNA were control ed less than 500 IU/mL and liver function returned to normal level. Log-rank test showed that there was no significant difference in the long-term survival rate after timely treatment of hepatitis B virus recurrence. With the prevention of nucleoside analogues combined with hepatitis B immunoglobulin therapy, timely treatment of hepatitis B recurrence has little influence on the prognosis. Entecavir combined with hepatitis B immunoglobulin can effectively prevent the hepatitis B recurrence. For the patients with hepatitis B virus-related risk factors, entecavir combined with hepatitis B immunoglobulin can better reduce the recurrence rate of hepatitis B than lamivudine+hepatitis B immunoglobulin after liver transplantation.关键词
器官移植/肝移植/乙型肝炎/乙型肝炎病毒相关性/YMDD变异/恩替卡韦/拉米夫定/核苷(酸)/人免疫球蛋白/复发Key words
organ transplantation/liver transplantation/hepatitis B/hepatitis B virus related/tyrosine-methionine-aspartate-aspartate mutation/entecavir/lamivudine/uucleoside/human immunoglobulin/recurrence分类
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高银杰,刘振文,张敏,苏海滨,周双男,周霞,张达利,贺希,汤汝佳..恩替卡韦联合人免疫球蛋白预防肝移植后乙肝复发★[J].中国组织工程研究,2013,(31):5588-5594,7.
