• 四川大學(xué)華西醫(yī)院肝臟移植中心（成都 610041）;;
  • 通訊作者： 嚴(yán)律南;

目的探討單一應(yīng)用拉米夫定預(yù)防良性乙肝相關(guān)性肝病肝移植術(shù)后乙肝病毒再感染的療效。
方法總結(jié)單一應(yīng)用拉米夫定預(yù)防肝移植術(shù)后生存時(shí)間大于3個(gè)月的31例良性乙肝相關(guān)性終末期肝病患者的乙肝病毒再感染情況，同時(shí)檢測(cè)肝移植手術(shù)前、后血清及肝穿刺組織乙肝表面標(biāo)志物及HBV DNA的變化。
結(jié)果31例患者隨訪(fǎng)時(shí)間平均為 38.2個(gè)月（3.2～70.2個(gè)月），隨訪(fǎng)期間死亡8例。乙肝病毒總的再感染率為19.4%（6/31），術(shù)后1、3、5年乙肝再感染率分別為7.1%(2/28)、16.0%(4/25)及26.1%(6/23)，生存率分別為87.1%(27/31)、80.6%(25/31)及66.1%(20.5/31)。術(shù)前HBeAg和HBV DNA的清除率分別為54.5%(6/11)和50.0%(5/10)。術(shù)前HBV DNA和HBeAg陽(yáng)性患者術(shù)后乙肝病毒再感染率高。
結(jié)論拉米夫定可以有效地預(yù)防良性乙肝相關(guān)性肝病患者肝移植術(shù)后乙肝病毒的再感染； 術(shù)前應(yīng)盡可能使HBV DNA和HBeAg轉(zhuǎn)陰。

引用本文： 嚴(yán)茂林,嚴(yán)律南,李波,曾勇,文天夫,王文濤,楊家印,徐明清,李志輝. 拉米夫定對(duì)肝移植術(shù)后乙肝病毒再感染的預(yù)防作用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006, 13(2): 205-207下轉(zhuǎn)210. doi: 復(fù)制

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10. Steinmuller T, Seehofer D, Rayes N, et al. Increasing applicability of liver transplantation for patients with hepatitis Brelated liver disease.
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14. Maruyama T, Mitsui H, Hanajiri K, et al. AntiHBs antibodies produced after liver transplantation: from the donor or the recipient?.
15. Seehofer D, Rays N, Steinmuller T, et al. Viral load at the time of liver transplantation and risk of hepatitis B virus recurrence [Ｊ]. Liver Transpl, 2005; 11(4)∶402.
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18. Akay S, Karasu Z, Akyildiz M, et al. Adefovir treatment in posttransplant hepatitis B virus infection resistant to lamivudine plus hepatitis B virus immunoglobulin.
19. Angus P, Vaughan R, Xiong S, et al. Resistance to adefovir dipivoxil therapy associated with the selection of a novel mutation in the HBV polymerase.
20. Zoulim F. Treatment of preand postliver transplantation HBVinfection: Should we aim at combination therapy? [Ｊ]. Hepatology, 2003； 38(6)∶1353.
21. Sponseller CA, Bacon BR, Disbisceglie AM. Clinical improvement in patients with decompensated liver disease caused by hepatitis B after treatment with lamivudine [Ｊ]. Liver Transpl,2000； 6(6)∶715.
22. Starkel P, Cicarelli O, Lerut J, et al. Limited lamivudine and longterm hepatitis B immunoglobulin immunoprophylaxis for prevention of hepatitis B recurrence after liver transplantation [Ｊ]. Transplantation, 2002； 74(3)∶408.
  1. 1. [Ｊ]. Hepatology, 1991； 13(4)∶619.
  2. 2. [Ｊ]. Hepatology, 2002； 35(6)∶1528.
  3. 3. [Ｊ]. Hepatogastroenterology, 1997； 44(15)∶808.
  4. 4. [Ｊ]. Transplant Proc， 1997； 29(6)∶2687.
  5. 5. [Ｊ]. Hepatology, 2003； 37(1)∶36.
  6. 6. [Ｊ]. Hepatology， 2003； 38(1)∶271.
  7. 7. [Ｊ]. Transplant Proc，2004； 36(9)∶2768.
  8. 8. [Ｊ]. Gastroenterology, 2003； 125(1)∶292.
  9. 9. Todo S, Demetris A, Van Thiel D, et al. Orthotopic liver transplantation for patients with hepatitis B virusrelated liver disease.
  10. 10. Steinmuller T, Seehofer D, Rayes N, et al. Increasing applicability of liver transplantation for patients with hepatitis Brelated liver disease.
  11. 11. BenAri Z, Shmueli D, Mor E, et al. Beneficial effect of lamivudine treatment of advanced and decompensated liver disease due to hepatitis B.
  12. 12. Nery JR, Weppler D, Rodiriguez M, et al. Efficacy of lamivudine in controlling hepatitis B virus recurrence after liver transplantation.
  13. 13. Lo CM, Fung JT, Lau GK, et al. Development of antibody to hepatitis B surface antigen after liver transplantation for chronic hepatitis B.
  14. 14. Maruyama T, Mitsui H, Hanajiri K, et al. AntiHBs antibodies produced after liver transplantation: from the donor or the recipient?.
  15. 15. Seehofer D, Rays N, Steinmuller T, et al. Viral load at the time of liver transplantation and risk of hepatitis B virus recurrence [Ｊ]. Liver Transpl, 2005; 11(4)∶402.
  16. 16. 鄭樹(shù)森， 吳健， 王偉林， 等. 拉米夫定預(yù)防肝移植術(shù)后乙型肝炎病毒再感染的作用 [Ｊ]. 中華醫(yī)學(xué)雜志， 2002； 82（7）∶445.
  17. 17. Steinberg JL, Yeo W, Zhong S, et al. Hepatitis B virus reactivation in patients undergoing cytotoxic chemotherapy for solid tumours: precore/core mutations may play an important role [Ｊ]. J Med Virol, 2000； 60(3)∶249.
  18. 18. Akay S, Karasu Z, Akyildiz M, et al. Adefovir treatment in posttransplant hepatitis B virus infection resistant to lamivudine plus hepatitis B virus immunoglobulin.
  19. 19. Angus P, Vaughan R, Xiong S, et al. Resistance to adefovir dipivoxil therapy associated with the selection of a novel mutation in the HBV polymerase.
  20. 20. Zoulim F. Treatment of preand postliver transplantation HBVinfection: Should we aim at combination therapy? [Ｊ]. Hepatology, 2003； 38(6)∶1353.
  21. 21. Sponseller CA, Bacon BR, Disbisceglie AM. Clinical improvement in patients with decompensated liver disease caused by hepatitis B after treatment with lamivudine [Ｊ]. Liver Transpl,2000； 6(6)∶715.
  22. 22. Starkel P, Cicarelli O, Lerut J, et al. Limited lamivudine and longterm hepatitis B immunoglobulin immunoprophylaxis for prevention of hepatitis B recurrence after liver transplantation [Ｊ]. Transplantation, 2002； 74(3)∶408.