肾移植患者接受 HBcAb 阳性供体时应用 HBIg预防乙肝的安全性和有效性

摘要

目的：探讨肾移植（KT）患者接受HBcAb阳性供体时应用乙肝免疫球蛋白（HBIg）预防乙肝的安全性和有效性。方法选择行同种异体KT患者69例，受体术前均无乙肝，供体均为HBsAg阴性、HBcAb-IgM阳性。将其随机分为观察组39例，KT前后应用小剂量HBIg；对照组30例不用HBIg。比较两组术后不同时间的肝肾功能及术后12、36个月乙肝发生率。结果观察组术后发生急性排斥1例。随访3～36个月，观察组术后8、12个月死于肺部感染2例，对照组术后6、24个月死于肺部感染、暴发性肝炎各1例。观察组术后12、36个月乙肝发生率分别为0、2．6％，对照组分别为10．3％、17．9％，两组比较P均＜0．05。两组术后12、24、36个月的血肌酐、总胆红素水平及24个月的肝功能异常率比较，P均＜0．05。结论 KT患者接受HBcAb-IgM阳性者的供肾时，预防性应用HBIg进行被动免疫，可有效降低乙肝发生率，改善其术后肝肾功能，延长生存时间。%Objective To investigate the safety and efficacy of using low dose of hepatitis B immunoglobulin (HBIg) from hepatitis B virus core antibody-positive donors for prevention of de novo hepatitis B infection after kidney transplantation (KT). Methods Sixty-nine patients who received KT without hepatitis B infection were retrospectively studied .All donors were hepati-tis B virus surface antigen (HBsAg) negative and HBcAb-IgM positive.We randomly divided them into the observation group (n=39) and the control group (n=30).All patients in the observation group were given low dose of HBIg injection before and af-ter transplantation.Patients in the control group were not treated with HBIg .The function of liver and kidney in the two groups was analyzed.The de novo HBV incidence after KT 12, 36 months were compared between the two groups.Results One case had acute rejection after operation in the observation group.During the follow-up of 3-36 months, 2 patients died of pulmonary infection after operation 8 and 12 months in the observation group, and 1 patients died of pulmonary infection 6 months after KT, 1 case died of acute hepatic failure 24 months after KT.The incidences of new onset hepatitis B 12 and 36 months after KT were 0 and 2.6%in the observation group, while those of the control group were 10.3%and 17.9%(all P<0.05 ).The differences were statistically significant in creatinine (Scr) and total bilirubin (TBiL) after 12,24 and 36 months of KT between the two groups as well as the abnormal rate of liver function in 24 months (all P<0.05).Conclusion When KT patients receive kid-neys from HBcAb-IgM positive donors, we preventively apply the HBIg to produce passive immunity, which can effectively re-duce the incidence of hepatitis B, improve the liver and renal function as well as prolong the survival time after operation .