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目的探讨拉米夫定预防和治疗肾移植患者乙型肝炎复发的效果。方法28例肾功能衰竭患者,肾移植术前乙型肝炎表面抗原(HBsAg)阳性,其中8例乙型肝炎病毒(HBV)DNA阳性,术前患者的肝功能正常,无肝脏纤维化。供者HBsAg均为阴性。20例接受拉米夫定预防性治疗,其中14例术前HBV DNA阴性者术后即刻接受拉米夫定治疗,6例HBV DNA阳性者术前即接受拉米夫定治疗;8例于肾移植术后出现肝功能异常时开始拉米夫定治疗。拉米夫定均为口服给药,起始量为100 mg/d。结果28例患者术后随访13～54个月,平均23.6个月,2例死亡。20例预防性用药者中,仅3例术前用药者术后9.3个月出现HBV DNA滴度增高,合并轻度肝功能异常,丙氨酸转氨酶(ALT)的平均峰值为87.5 U/L,拉米夫定治疗后肝功能恢复正常,HBV DNA转阴;另外17例治疗期间HBV DNA阴性,肝功能正常。未预防用药的8例,术后4.6个月时HBV DNA转为阳性(或HBV DNA滴度明显升高),肝功能异常,ALT的平均峰值为174.5 U/L,给予拉米夫定后,肝功能恢复正常,HBV DNA转阴,但有5例在治疗期间HBV DNA反复阳性。在拉米夫定治疗期间,28例患者的血肌酐维持在正常水平,未出现严重的药物不良反应。结论HBsAg阳性的肾移植患者,在出现肝功能异常前使用拉米夫定,对于预防乙型肝炎复发是安全、有效的。
Objective To investigate the efficacy of lamivudine in the prevention and treatment of hepatitis B recurrence in renal transplant recipients. Methods Twenty - eight patients with renal failure who were positive for hepatitis B surface antigen (HBsAg) before kidney transplantation, of which 8 were positive for hepatitis B virus (HBV) DNA and had normal hepatic function without liver fibrosis. Donor HBsAg are negative. Of the 20 patients who received lamivudine prophylaxis, 14 patients with preoperative HBV DNA negative were treated with lamivudine immediately after operation, 6 patients with positive HBV DNA were treated with lamivudine preoperatively, and 8 patients were treated with lamivudine Lamivudine treatment begins when liver dysfunction occurs after transplantation. Lamivudine are administered orally in an initial dose of 100 mg / d. Results 28 patients were followed up for 13 to 54 months with an average of 23.6 months and 2 patients died. Of the 20 prophylactic drug users, only 3 of the preoperative drug users had an increase in HBV DNA titer 9.3 months postoperatively with mild liver dysfunction. The average peak value of alanine aminotransferase (ALT) was 87.5 U / L, Liver function returned to normal after lamivudine treatment, with negative HBV DNA; in the other 17 cases, HBV DNA was negative and liver function was normal during treatment. 8 cases of non-prophylaxis, HBV DNA turned positive (or HBV DNA titer was significantly increased) 4.6 months after surgery, abnormal liver function, the average peak value of ALT 174.5 U / L, given lamivudine, Liver function returned to normal, with negative HBV DNA, but 5 were repeatedly positive for HBV DNA during treatment. During lamivudine treatment, serum creatinine was maintained at normal levels in 28 patients without serious adverse drug reactions. Conclusions In patients with HBsAg positive renal transplantation, the use of lamivudine before the onset of liver dysfunction is safe and effective in preventing the recurrence of hepatitis B.