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目的:探讨拉米夫定(LAM)联合乙肝免疫球蛋白(HBIG)预防乙肝病毒(HBV)携带者肾移植术后乙肝活动的疗效。方法:2003年7月至2007年11月共24例HBsAg阳性患者入组。术后随机分为LAM组(11例)和LAM+HBIG组(13例)。观察肾移植术后两组受者HBV复制、ALT变化,分析其与急性排斥反应发生及与预后的关系。结果:随访期间LAM组受者乙肝复发率为18.2%(2/11),2例死于乙肝复发所致急性肝功能衰竭,2例移植肾丢失,人存活率为81.8%(9/11),移植肾存活率为63.6%(7/11);LAM+HBIG组受者无乙肝复发,随访期间无死亡及移植肾无丢失者,人、肾存活率均为100%。结论:LAM联合HBIG预防性治疗乙肝活动的肾移植受者,能够减少术后的乙肝复发率,进一步提高这类受者的人/肾存活率。
Objective: To investigate the efficacy of lamivudine (LAM) in combination with hepatitis B immunoglobulin (HBIG) in preventing hepatitis B infection after renal transplantation in patients with hepatitis B virus (HBV) infection. Methods: From July 2003 to November 2007 a total of 24 cases of HBsAg positive patients into the group. The patients were randomly divided into LAM group (n = 11) and LAM + HBIG group (n = 13). The changes of HBV replication and ALT in two groups of recipients after renal transplantation were observed, and their relationship with the occurrence of acute rejection and prognosis were analyzed. Results: The recurrence rate of hepatitis B in LAM group was 18.2% (2/11) during the follow-up period, 2 died of acute liver failure caused by recurrent hepatitis B, 2 lost the transplanted kidney, the survival rate was 81.8% (9/11) , And graft survival rate was 63.6% (7/11). No recurrence of hepatitis B was found in recipients of LAM + HBIG group. No deaths were found during follow-up and no graft loss was found. The survival rates of human and kidney were all 100%. CONCLUSIONS: LAM combined with HBIG prophylactic treatment of hepatitis B transplant recipients can reduce the postoperative recurrence rate of hepatitis B and further enhance the human / kidney survival rate of these recipients.