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目的回顾分析拉米夫定对免疫受损宿主HBV再激活的预防作用。方法将2003~2006年之间符合入组条件的免疫受损宿主分为2组:拉米夫定预防组和对照组,进行比较。预防组是在应用免疫抑制剂或细胞毒性化疗之前2周左右开始使用拉米夫定0.1g口服,1次/d,进行预防性治疗;对照组在使用免疫抑制剂或细胞毒性化疗之前未使用拉米夫定预防性治疗,在宿主出现HBV再激活表现时开始用相同剂量进行治疗。分别比较免疫抑制治疗或细胞毒性化疗前2周及开始后4周检测的肝功能、HBV标志物及HBV病毒定量。结果拉米夫定预防组在使用免疫抑制剂或细胞毒性药物过程中及结束后,8.3%(1/12)出现HBV再激活表现;对照组85.7%(12/14)出现HBV再激活,其中1例死于暴发性肝衰竭,1例死于原发病。结论早期应用拉米夫定可有效预防免疫受损宿主HBV再激活。
Objective To review the preventive effect of lamivudine on HBV reactivation in immunocompromised hosts. Methods Immunocompromised hosts who met the inclusion criteria between 2003 and 2006 were divided into two groups: lamivudine prevention group and control group, which were compared. The prophylaxis group was started prophylactic treatment with lamivudine 0.1 g orally, once per day for about 2 weeks prior to the application of immunosuppressive agents or cytotoxic chemotherapy; the control group was not used prior to the use of immunosuppressive agents or cytotoxic chemotherapy Lamivudine prophylactic treatment begins with the same dose of treatment when the host appears HBV reactivation. The liver function, HBV markers and HBV virus levels were compared between two weeks before and after immunosuppressive therapy or cytotoxic chemotherapy respectively. Results HBV reactivation occurred in 8.3% (1/12) of the patients in the lamivudine prevention group and during and after immunosuppressive agents or cytotoxic drugs. In the control group, HBV reactivation occurred in 85.7% (12/14) One died of fulminant hepatic failure and one died of primary disease. Conclusions Early use of lamivudine can effectively prevent HBV reactivation in immunocompromised hosts.