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目的探讨拉米夫定对异基因造血干细胞移植患者乙型肝炎病毒再激活的预防作用。方法2003年1月至2004年1月南京市鼓楼医院血液科3例行异基因造血干细胞移植的白血病患者中,2例乙型肝炎病毒表面抗原(HBsAg)阳性,HBV DNA分别为4.75×106拷贝·mL-1和1.15×106拷贝·mL-1。另1例HBsAg阴性,但其供者HBsAg阳性,HBV DNA为3.48×107拷贝·mL-1。对2例HBsAg阳性受者,移植前用拉米夫定;对HbsAg阴性受者干细胞回输时开始用拉米夫定,剂量均为0.1g每日1次,用至移植后1年。结果其中1例HBsAg阳性患者在移植后1个月内HBV DNA较高,波动于(1~1.2)×105拷贝·mL-1,1个月后HBV DNA降低,<3×104拷贝·mL-1。移植后1周丙氨酸转氨酶(ALT)升高,最高达152U/L,持续1周后恢复正常。另1例移植后HBV DNA较低,持续<1×105拷贝·mL-1。无明显肝功能损害,ALT最高达56U/L。接受供者HB-sAg阳性患者移植后HBeAb阳性,HBcAb阳性,HBV DNA<1×103拷贝·mL-1。移植后10dALT升高,最高达205U/L,持续1周后恢复正常。3例患者长期服用拉米夫定耐受性好,无明显毒副反应。结论初步观察表明,拉米夫定可以预防异基因造血干细胞移植患者乙型肝炎病毒再激活,无明显毒副反应。
Objective To investigate the preventive effect of lamivudine on hepatitis B virus (HBV) reactivation in patients with allogeneic hematopoietic stem cell transplantation. Methods From January 2003 to January 2004, three patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation in Department of Hematology, Drum Tower Hospital of Nanjing City, two were positive for hepatitis B virus surface antigen (HBsAg) with HBV DNA of 4.75 × 106 copies · ML-1 and 1.15 × 106 copies · mL-1. Another case of HBsAg-negative, but its donor HBsAg-positive, HBV DNA was 3.48 × 107 copies · mL-1. For 2 HBsAg-positive recipients, lamivudine was given before transplantation; lamivudine was started on the transfusion of HbsAg-negative recipient stem cells at a dose of 0.1 g once daily until 1 year after transplantation. Results One of the HBsAg positive patients had high HBV DNA within 1 month after transplantation. The HBV DNA level was lower in the range of 1 to 1.2 × 105 copies · mL-1 and 1 month after transplantation. The HBV DNA level was lower than 3 × 104 copies · mL- 1. One week after transplantation, alanine aminotransferase (ALT) increased up to 152U / L, returned to normal after 1 week. The other one had lower HBV DNA after transplantion, lasting <1 × 105 copies · mL-1. No significant liver damage, ALT up to 56U / L. HBeAb-positive, HBcAb-positive HBV DNA was <1 × 10 3 copies · mL-1 after transplantation in HBsAg-positive patients. After 10d transplantation, the level of ALT increased up to 205U / L and returned to normal after 1 week. Long-term use of lamivudine 3 patients tolerated, no significant side effects. Conclusions Preliminary observations indicate that lamivudine can prevent the reactivation of hepatitis B virus in allogeneic hematopoietic stem cell transplantation patients with no obvious side effects.