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

目的探討單一應用拉米夫定預防良性乙肝相關性肝病肝移植術后乙肝病毒再感染的療效。
方法總結(jié)單一應用拉米夫定預防肝移植術后生存時間大于3個月的31例良性乙肝相關性終末期肝病患者的乙肝病毒再感染情況，同時檢測肝移植手術前、后血清及肝穿刺組織乙肝表面標志物及HBV DNA的變化。
結(jié)果31例患者隨訪時間平均為 38.2個月（3.2～70.2個月），隨訪期間死亡8例。乙肝病毒總的再感染率為19.4%（6/31），術后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)。術前HBeAg和HBV DNA的清除率分別為54.5%(6/11)和50.0%(5/10)。術前HBV DNA和HBeAg陽性患者術后乙肝病毒再感染率高。
結(jié)論拉米夫定可以有效地預防良性乙肝相關性肝病患者肝移植術后乙肝病毒的再感染； 術前應盡可能使HBV DNA和HBeAg轉(zhuǎn)陰。

引用本文： 嚴茂林,嚴律南,李波,曾勇,文天夫,王文濤,楊家印,徐明清,李志輝. 拉米夫定對肝移植術后乙肝病毒再感染的預防作用. 中國普外基礎與臨床雜志, 2006, 13(2): 205-207下轉(zhuǎn)210. doi: 復制

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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.
16. 鄭樹森， 吳健， 王偉林， 等. 拉米夫定預防肝移植術后乙型肝炎病毒再感染的作用 [Ｊ]. 中華醫(yī)學雜志， 2002； 82（7）∶445.
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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. 鄭樹森， 吳健， 王偉林， 等. 拉米夫定預防肝移植術后乙型肝炎病毒再感染的作用 [Ｊ]. 中華醫(yī)學雜志， 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.