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目的探讨重型乙型肝炎肝移植术后乙型肝炎病毒(HBV)再感染的防治。方法回顾性分析了73例重型乙型肝炎患者,移植前后给予抗病毒药物预防乙型肝炎病毒再感染,拉米夫定+乙肝免疫球蛋白(HBIG)71例,阿德夫韦+拉米夫定+乙肝免疫球蛋白2例,观察临床表现、血清HBSAg、血清HBeAg、血清HBV DNA及肝活检免疫组织化学检测等指标。结果应用拉米夫定+HBIG预防的71例中,有2例再感染,血清HBSAg为阳性,肝活检免疫组织化学检测有HBSAg表达,其中1例血清HBV DNA阳性,另1例经治疗后HBSAg又转阴。用阿德夫韦+拉米夫定+HBIG预防的2例中,血清学和肝活检免疫组织化学检测均无HBSAg表达。结论拉米夫定+HBIG或拉米夫定+阿德夫韦+HBIG联合应用以及合理的使用免疫抑制剂可以有效预防重型乙型肝炎患者移植术后乙型肝炎病毒的再感染。
Objective To investigate the prevention and treatment of Hepatitis B virus (HBV) reinfection after severe hepatitis B liver transplantation. Methods A retrospective analysis of 73 patients with severe hepatitis B before and after transplantation of antiviral drugs to prevent hepatitis B virus reinfection, 71 cases of lamivudine + hepatitis B immunoglobulin (HBIG), adefovir + Lamiv Two cases of definite + hepatitis B immunoglobulin, clinical manifestations, serum HBsAg, serum HBeAg, serum HBV DNA and liver biopsy immunohistochemical detection and other indicators. Results Among the 71 patients who were treated with lamivudine plus HBIG, 2 were re-infected and the serum HBsAg was positive. HBSAg expression was detected by immunohistochemistry in liver biopsy. One patient had positive serum HBV DNA and the other one had HBSAg Turn negative. In the two cases of adefovir + lamivudine + HBIG prophylaxis, no serological and liver biopsy immunohistochemical detection of HBSAg expression. Conclusions The combined use of lamivudine + HBIG or lamivudine + adevovib + HBIG and the rational use of immunosuppressive agents can effectively prevent the reinfection of hepatitis B virus in patients with severe hepatitis B after transplantation.