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目的探讨单一应用拉米夫定预防良性乙肝相关性肝病肝移植术后乙肝病毒再感染的疗效。方法总结单一应用拉米夫定预防肝移植术后生存时间大于3个月的31例良性乙肝相关性终末期肝病患者的乙肝病毒再感染情况,同时检测肝移植手术前、后血清及肝穿刺组织乙肝表面标志物及HBV DNA的变化。结果31例患者随访时间平均为38.2个月(3.2~70.2个月),随访期间死亡8例。乙肝病毒总的再感染率为19.4%(6/31),术后1、3、5年乙肝再感染率分别为7.1%(2/28)、16.0%(4/25)及26.1%(6/23),生存率分别为87.1%(27/31)、80.6%(25/31)及66.1%(20.5/31)。术前HBeAg和HBV DNA的清除率分别为54.5%(6/11)和50.0%(5/10)。术前HBV DNA和HBeAg阳性患者术后乙肝病毒再感染率高。结论拉米夫定可以有效地预防良性乙肝相关性肝病患者肝移植术后乙肝病毒的再感染;术前应尽可能使HBV DNA和HBeAg转阴。
Objective To investigate the efficacy of lamivudine alone in the prevention of hepatitis B virus reinfection in patients with benign hepatitis B-associated liver disease after liver transplantation. Methods A total of 31 patients with benign hepatitis B-related end-stage liver disease who survived more than 3 months after lamivudine alone were enrolled were enrolled in this study. HBV re-infection was detected before and after liver transplantation. Serum and liver biopsies Changes of hepatitis B surface markers and HBV DNA. Results The average follow-up time of 31 patients was 38.2 months (3.2-70.2 months), and 8 patients died during follow-up. The total re-infection rate of hepatitis B virus was 19.4% (6/31). The rates of re-infection of hepatitis B were 7.1% (2/28), 16.0% (4/25) and 26.1% (6/31) respectively at 1, / 23). The survival rates were 87.1% (27/31), 80.6% (25/31) and 66.1% (20.5 / 31), respectively. Preoperative HBeAg and HBV DNA clearance rates were 54.5% (6/11) and 50.0% (5/10), respectively. Preoperative HBV DNA and HBeAg positive patients postoperative hepatitis B re-infection rate. Conclusion Lamivudine can effectively prevent hepatitis B virus re-infection after liver transplantation in patients with benign hepatitis B-related liver disease. HBV DNA and HBeAg should be negative before surgery.