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【文摘发布】HBIG联合核苷类似药预防乙肝复发在停用HBIG后乙肝复发风险低

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Title:Low risk of hepatitis B virus recurrence after withdrawal of long-term hepatitis B immunoglobulin in patients receiving maintenance nucleos(t)ide analogue therapy.

Author:Wong SN, Chu CJ, Wai CT, Howell T, Moore C, Fontana RJ, Lok AS

source:Liver Transpl. 2007 Mar;13(3):374-81.

IF:4.225(2005)

Hepatitis B virus (HBV) recurrence rates of 0-16% had been reported in patients maintained on nucleoside analogues (NA) after hepatitis B immunoglobulin (HBIG) discontinuation after orthotopic liver transplantation (OLT). However, follow-up in most studies was short. We aimed to determine the long-term risk of HBV recurrence using this strategy. All HBV patients who received > or =7 doses of intravenous HBIG after OLT, with no HBV recurrence while receiving HBIG, and who eventually discontinued HBIG and were maintained on NA, were included. HBV recurrence was defined as HBsAg-positive or HBV DNA > or =5 log copies/mL on 2 consecutive occasions. Twenty-one patients met the inclusion criteria. Immediate post-OLT prophylaxis was combination HBIG and NA in 15 patients, whereas 6 patients received HBIG monotherapy for 62-109 months before NA was added. HBIG was discontinued a median of 26 (range, 0.2-121) months after OLT. Median follow-up post-HBIG discontinuation was 40 (range, 5-51) months. Only 1 patient, who had 12 months of HBIG and was noncompliant to NA therapy, had HBV recurrence, 34 months after HBIG discontinuation. One patient had HBV DNA of 3.3 log copies/mL 47 and 48 months after HBIG discontinuation but remained HBsAg-negative. Lamivudine-resistant mutations were detected in both patients. Probability of HBV recurrence was 0% and 9% at 2 and 4 years after HBIG discontinuation. Three patients had 1-2 episodes of transiently detectable HBV DNA. All were HBV DNA and HBsAg negative on repeated tests over a period of 2-36 months. Maintenance therapy with NA after discontinuation of long-term HBIG therapy is associated with a low risk of HBV recurrence after OLT in compliant HBV patients.

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2007-06-13 18:35 浏览 : 1159 回复 : 1

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2007-06-13 20:27

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Title:Low risk of hepatitis B virus recurrence after withdrawal of long-term hepatitis B immunoglobulin in patients receiving maintenance nucleoside analogue therapy.
题目：HBIG联合核苷类似药预防乙肝复发在停用HBIG后乙肝复发风险低
Author:Wong SN, Chu CJ, Wai CT, Howell T, Moore C, Fontana RJ, Lok AS
作者：Wong SN, Chu CJ, Wai CT, Howell T, Moore C, Fontana RJ, Lok AS
source:Liver Transpl. 2007 Mar;13(3):374-81.
来源：《肝脏移植学》. 2007 Mar;13(3):374-81.
IF:4.225(2005)
影响因子：4.225(2005)
Hepatitis B virus (HBV) recurrence rates of 0-16% had been reported in patients maintained on nucleoside analogues (NA) after hepatitis B immunoglobulin (HBIG) discontinuation after orthotopic liver transplantation (OLT).
据报道，原位肝移植（OLT）术后持续服用核苷类似物（NA）的病人在停用乙肝免疫球蛋白（HBIG）后乙肝复发率为0-16%。

However, follow-up in most studies was short. We aimed to determine the long-term risk of HBV recurrence using this strategy.
然而，大部分研究的随访期都较短。我们研究的目的是为了了解接受该方案治疗的病人的远期乙肝复发风险。
All HBV patients who received > or =7 doses of intravenous HBIG after OLT, with no HBV recurrence while receiving HBIG, and who eventually discontinued HBIG and were maintained on NA, were included. HBV recurrence was defined as HBsAg-positive or HBV DNA > or =5 log copies/mL on 2 consecutive occasions.
研究所纳入的病例为原位肝移植术后静脉使用HBIG超过七次、使用HBIG期间无乙肝复发、并且最后停止使用HBIG和持续服用核苷类似物的乙肝患者。乙肝复发的定义是连续两次检查均HBsAg阳性或HBV DNA定量大于等于5 log copies/mL。

Twenty-one patients met the inclusion criteria. Immediate post-OLT prophylaxis was combination HBIG and NA in 15 patients, whereas 6 patients received HBIG monotherapy for 62-109 months before NA was added. HBIG was discontinued a median of 26 (range, 0.2-121) months after OLT.
结果二十一名病人符合纳入标准。其中十五名病人在原位肝移植术后立即使用HBIG和核苷类似物以预防乙肝复发，而其余六名病人在加用核苷类似物之前接受了62-109个月的HBIG单药疗法。在原位肝移植术后平均26（范围0.2-121个月）个月HBIG被停用。

Median follow-up post-HBIG discontinuation was 40 (range, 5-51) months. Only 1 patient, who had 12 months of HBIG and was noncompliant to NA therapy, had HBV recurrence, 34 months after HBIG discontinuation.
在停用HBIG后平均随访40个月（范围为5-51个月）。只有一名病人在停用HBIG34个月后发生乙肝复发，该病人共使用了12个月的HBIG，并拒绝接受核苷类似物治疗。

One patient had HBV DNA of 3.3 log copies/mL 47 and 48 months after HBIG discontinuation but remained HBsAg-negative. Lamivudine-resistant mutations were detected in both patients. Probability of HBV recurrence was 0% and 9% at 2 and 4 years after HBIG discontinuation. Three patients had 1-2 episodes of transiently detectable HBV DNA. All were HBV DNA and HBsAg negative on repeated tests over a period of 2-36 months.
一名病人在停用HBIG后第47和48个月HBV DNA定量为3.3log copies/ml，但HBsAg为阴性。在两名病人中均检测到拉米夫定耐药性。停用HBIG后第二年和第四年的乙肝复发概率分别为0%和9%。三名病人曾有过1-2次被检测到HBV DNA，但仅为暂时性的。所有病人在2-36个月内反复检测HBV DNA和HBsAg均为阴性。

Maintenance therapy with NA after discontinuation of long-term HBIG therapy is associated with a low risk of HBV recurrence after OLT in compliant HBV patients.
由此我们得出结论：对于依从性好的乙肝病人，在长期的HBIG治疗后持续服用核苷类似物可降低原位肝移植术后乙肝复发风险。

编译：共538字
【据《肝脏移植学》2007年3月报道】题目：HBIG联合核苷类似药预防乙肝复发在停用HBIG后乙肝复发风险低（作者Wong等）

据报道，原位肝移植（OLT）术后持续服用核苷类似物（NA）的病人在停用乙肝免疫球蛋白（HBIG）后乙肝复发率为0-16%。然而，大部分研究的随访期都较短。我们研究的目的是为了了解接受该方案治疗的病人的远期乙肝复发风险。研究所纳入的病例为原位肝移植术后静脉使用HBIG超过七次、使用HBIG期间无乙肝复发、并且最后停止使用HBIG和持续服用核苷类似物的乙肝患者。乙肝复发的定义是连续两次检查均HBsAg阳性或HBV DNA定量大于等于5 log copies/mL。
结果共有二十一名病人符合纳入标准。其中十五名病人在原位肝移植术后立即使用HBIG和核苷类似物以预防乙肝复发，而其余六名病人在加用核苷类似物之前接受了62-109个月的HBIG单药疗法。在原位肝移植术后平均26（范围0.2-121个月）个月HBIG被停用。在停用HBIG后平均随访40个月（范围为5-51个月）。只有一名病人在停用HBIG34个月后发生乙肝复发，该病人共使用了12个月的HBIG，并拒绝接受核苷类似物治疗。一名病人在停用HBIG后第47和48个月HBV DNA定量为3.3log copies/ml，但HBsAg为阴性。在两名病人中均检测到拉米夫定耐药性。停用HBIG后第二年和第四年的乙肝复发概率分别为0%和9%。三名病人曾有过1-2次被检测到HBV DNA，但仅为暂时性的。所有病人在2-36个月内反复检测HBV DNA和HBsAg均为阴性。由此我们得出结论：对于依从性好的乙肝病人，在长期的HBIG治疗后持续服用核苷类似物可降低原位肝移植术后乙肝复发风险。

2007-06-14 20:43

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