儿童活体肝移植术后新发乙型肝炎病毒感染的研究

发布时间：2018-01-06 22:40

本文关键词：儿童活体肝移植术后新发乙型肝炎病毒感染的研究　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的随着肝移植手术技术的发展,肝移植已经成为终末期肝病的有效治疗手段。越来越多原发病为胆道闭锁或其他代谢性疾病的婴幼儿及儿童接受肝移植术,成为儿童终末期肝病的根治性治疗手段,挽救其生命。近年来,小儿肝移植受者术前绝大部分为非病毒性肝炎相关性的终末期肝病。肝移植术后免疫抑制剂的使用,以及患儿术后体质状态,均可增加感染乙型肝炎的风险,一旦感染乙型肝炎病毒造成移植肝损伤,影响患儿的长期生存。研究儿童活体肝移植术后新发乙型肝炎病毒感染的临床特点,并探讨其防治策略方法对2010年7月至2014年7月期间儿童活体肝移植受者,进行回顾性分析,排除标准包括失访,资料不全,6个月内死亡。所有入选患儿的病例筛查记录,包括:供受者性别,年龄,手术日期,术前术后接种疫苗情况;术前术后HBV血清学标志物:HBsAg,Anti-HBs,HBeAg,Anti-HBe,Anti-HBc;术前术后血清HBV-DNA(值小于100IU/mL是阴性);肝移植术前PELD评分;Child-Pugh评分;手术时间、术中HBIG用量、术中输血(红细胞、血浆用量);术后有无预防乙型肝炎病毒方案以及随访时间。所有临床资料进行随访至2014年12月。结果2010年7月至2014年7月共有115例患儿,9例患儿被排除,共收集儿童活体肝移植供受者资料106例,中位随访时间为19.5个月(5-44个月),共有9例患儿出现新发乙型肝炎(9/106,8.39%)。Anti-HBc阳性供肝组新发乙型肝炎为8例(8/45,17.78%),在供肝Anti-HBc阳性组中给予核苷类似物预防性抗乙型肝炎病毒治疗14例,无1例新发乙型肝炎,未给予预防性治疗的新发乙型肝炎为8例(8/31,25.8%)。在供肝Anti-HBc阳性的儿童患者中,术后是否应用预防性抗乙型肝炎病毒治疗以及患者术前Anti-HBs的滴度,与术后新发乙型肝炎有相关性(P值=0.043,P值=0.036)。术前给予接种乙肝疫苗的14例患者中,无1例新发乙型肝炎。结论Anti-HBc阳性供肝的儿童活体肝移植术后新发乙型肝炎的发生率明显高于Anti-HBc阴性供肝的儿童活体肝移植术后新发乙型肝炎的发生率。在供体Anti-HBc阳性的肝移植受体术后使用核苷类似物可预防新发乙型肝炎的发生。移植术前对供受者接种乙型肝炎疫苗可作为术后预防新发乙型肝炎的策略。肝移植术后定期检测HBV血清学标志物是必要的。
[Abstract]:Objective with the development of surgical technique in liver transplantation, liver transplantation has become an effective treatment for end-stage liver disease. More and more as the primary disease of infants and children with biliary atresia or other metabolic diseases underwent liver transplantation, as children of end-stage liver disease in radical treatment, save their lives. In recent years, pediatric liver transplantation recipients before the vast majority of correlation between non viral hepatitis end-stage liver disease. Immunosuppression after liver transplantation, and the postoperative patients with physical condition, can increase the risk of infection of hepatitis B, hepatitis B virus infection once caused by transplantation of liver injury, the impact of long-term survival in children. The clinical characteristics of children living donor liver after transplantation of new hepatitis B virus infection, and explore the strategy of prevention and treatment methods during July 2010 to July 2014 children living donor liver transplant recipients were analyzed retrospectively. Analysis and exclusion criteria included lost, incomplete information, the death of 6 months. All patients were cases of screening records, including donor sex, age, date of surgery, preoperative and postoperative situation of vaccination; preoperative and postoperative serum HBV markers: HBsAg, Anti-HBs, HBeAg, Anti-HBe, Anti-HBc; preoperative and postoperative serum HBV-DNA (less than 100IU/mL is negative) before liver transplantation; PELD score; Child-Pugh score; the operation time, intraoperative HBIG dosage, intraoperative blood transfusion (red blood cell, plasma volume); after operation, no scheme of prevention of hepatitis B virus and follow-up time. All clinical data were followed up to results from July 2010 to July 2014 December 2014. A total of 115 patients, 9 patients were excluded, were collected from children living donor liver transplantation recipients 106 cases, the median follow-up time was 19.5 months (5-44 months), there were 9 cases of children with new onset hepatitis B (9/106,8.39%).Anti-HBc Yang Liver group new onset hepatitis B 8 cases (8/45,17.78%), given nucleoside analogues in the liver of Anti-HBc positive group in preventive treatment of chronic hepatitis B in 14 cases, 1 new cases of hepatitis B, not given prophylactic treatment for 8 cases of new onset hepatitis B (8/31,25.8%) in the liver. Children with Anti-HBc positive patients, whether the application of preventive treatment of chronic hepatitis B and the titer of patients before Anti-HBs after operation, a new relationship between hepatitis and postoperative (P = =0.043, P = =0.036). Preoperative administration of 14 cases of hepatitis B vaccination in patients, 1 new cases of hepatitis B. The incidence of new onset hepatitis B new onset hepatitis B conclusion Anti-HBc positive donor liver after living donor liver transplantation in children was significantly higher than that in Anti-HBc negative liver after pediatric living donor liver transplantation. The donor Anti-HBc positive after liver transplantation using nucleoside analog It can prevent the occurrence of new hepatitis B. Before inoculation, hepatitis B vaccine can be used as a strategy to prevent new hepatitis B after liver transplantation. Regular detection of HBV serological markers after liver transplantation is necessary.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R726.5

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