乙型肝炎病毒感染对造血干细胞移植后肝脏功能的影响

摘要

To analyze the impact of hepatitis B virus (HBV) infection on liver function of patients after hematopoietic stem cell transplantation ( HSCT), the transplantation outcome of 48 patients infected with HBV prior to transplantation among 185 patients received HSCT was investigated retrospectively. The results showed that during a follow-up for 6 months after HSCT, the alanine aminotransferase( ALT) peak average values of the patients with HBsAg ( + ), HBsAb( + ) and control groups were (281. 6 ?14.6) ,(95.4+79.9) and (65. 1 ?4.2) U/L, respectively. The incidences of abnormal liver function of the patients with HBsAg ( + ), HBsAb ( + ) and control groups were 61. 54% ,40.00% and 30.23% respectively. There were no significant differences between any two groups (P>0.05). The lethality of those patients at late period after transplantation was not related to HBV infection. The hepatocirrhosis and hepatocarcinoma caused by HBV infection have not become major problems in long-term survivors. It is concluded that in HBsAg( + ) patients received HSCT, the damage of liver function is more severe than control group, possibly increasing the development of abnormal liver function. The measures against the liver function damage should be taken. The prophylactic administration of ganciclovir for virus may be effective to prevent the activation of HBV.%本研究旨在分析乙型肝炎病毒(HBV)感染对造血干细胞移植(HSCT)后肝功能的影响.对我院2000年1月-2010年5月间行HSCT的患者中48例HBV感染的患者临床资料进行回顾性分析.结果表明:在移植后6个月内,HBsAg(+)组、HBsAb(+)组和对照组患者谷丙转氨酶(ALT)的峰值分别为(281.6±414.6)、(95.4±79.9)和(65.1±44.2)U/L,肝功能明显异常发生率分别为61.54％,40.00％和30.23％,任2组之间比较均无统计学显著差异(P＞0.05).HBsAg(+)组2例患者在移植后早期出现致死性的急性肝功能衰竭,发生率为15.4％ (2/13),其中1例可能与HBV激活有关.1例移植前应用更昔洛韦抗病毒治疗的患者,移植后没有出现肝功能损害的表现.结论:HBsAg(+)患者接受HSCT时,肝功能损害较对照组更为严重,应加强保肝治疗.移植前预防性的更昔洛韦抗病毒治疗可能对预防HBV的激活有效.