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目的探讨和评价拉米夫定预防原位肝移植术后乙型肝炎病毒(HBV)再感染的效果。方法41例患者,术前诊断为肝炎后肝硬化(失代偿期)者22例,慢性重型肝炎并肝炎后肝硬化(失代偿期)者12例,慢性重型肝炎者7例,其中HBV DNA阳性16例。41例患者均采用背驮式原位肝移植,术前15例给予拉米夫定治疗,术后41例患者均服用拉米夫定。结果10例患者术后出现HBV再感染,其中9例为YMDD变异毒株感染,术后1、2年的HBV再感染率分别为9.8%(4/41)、24.4%(10/41)。术前血清HBV DNA阴性者术后HBV再感染率(12.0%,3/25)明显低于HBVDNA阳性者(43.8%,7/16)。术前长期服用(超过6个月)拉米夫定者和未服用拉米夫定者术后HBV再感染率分别为66.7%、23.1%,均明显高于术前短期(未超过6个月)服用拉米夫定者(0,P<0.05)。结论术前服用拉米夫定可降低乙型肝炎患者肝移植后HBV再感染率,但服药时间不宜超过6个月;长期、单一的应用拉米夫定易导致病毒变异而出现耐药毒株感染。
Objective To investigate and evaluate the efficacy of lamivudine in prevention of hepatitis B virus (HBV) reinfection after orthotopic liver transplantation. Methods Twenty-one patients were diagnosed as hepatitis B after liver cirrhosis (decompensation), 12 patients with chronic severe hepatitis and post-hepatitis cirrhosis (decompensated), and 7 patients with chronic severe hepatitis 16 cases of DNA positive. All 41 patients were treated with piggyback orthotopic liver transplantation. Fifteen patients were treated with lamivudine before surgery. All 41 patients received lamivudine after operation. Results Ten patients were re-infected with HBV after operation. Among them, 9 were infected with YMDD mutant strains. The HBV re-infection rates at 1 and 2 years after operation were 9.8% (4/41) and 24.4% (10/41), respectively. Preoperative serum HBV DNA negative postoperative HBV re-infection rate (12.0%, 3/25) was significantly lower than HBVDNA positive (43.8%, 7/16). Long-term preoperative use (more than 6 months) lamivudine and no lamivudine postoperative HBV re-infection rates were 66.7%, 23.1%, were significantly higher than preoperative short-term (less than 6 months ) Took lamivudine (0, P <0.05). Conclusion Preoperative lamivudine can reduce HBV re-infection rate after liver transplantation in patients with hepatitis B, but should not take more than 6 months; long-term, single application of lamivudine easily lead to mutations in the emergence of drug-resistant strains infection.