在异基因骨髓移植后，乙肝携带者中暴发性肝炎的发生率显著增加。

Fulminant hepatitis is significantly increased in hepatitis B carriers after allogeneic bone marrow transplantation.

作者信息

Chen P M, Chiou T J, Fan F S, Liu J M, Hsieh R K, Yen C C, Wang W S, Liu J H

机构信息

Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.

出版信息

Transplantation. 1999 Jun 15;67(11):1425-33. doi: 10.1097/00007890-199906150-00006.

DOI:10.1097/00007890-199906150-00006

PMID:10385080

Abstract

BACKGROUND

Bone marrow transplantation (BMT) is effective treatment for many hematologic disease, but performed in a population with a high endemic hepatitis B virus carrier rate, the incidence of liver function impairment and fulminant hepatitis (FH) is expected to be raised.

METHODS

Forty-three hepatitis B virus carriers received high-dose chemotherapy and BMT, 32 patients received an allogeneic graft, and 11 patients autologous marrow. Acute graft-versus-host disease prophylaxis consisted of methotrexate on day 1, 3, 6, and 11 and cyclosporine for 6 months.

RESULTS

After a median follow-up period of 68 months (range: 1-11.5 years), 26 (81.3%) allogeneic BMT patients developed impaired liver function (LF), 5 progressed to FH on day 93, 169, 170, 180, and 468, respectively, and died after an average of 13.8 days (range: 1-45 days). Whereas only 4 (36.4%) autologous BMT patients developed impaired LF, and none FH. Impaired LF (P=0.026, chi-square), and FH (odds ratio=12.86, P=0.009 for coefficient) were significantly related to an allogeneic marrow graft, and the timing of liver function impairment coincided with cyclosporine withdrawal. Hepatitis B surface antigen (HbsAg) disappeared from the serum in 4/14 (28.6%) patients receiving a marrow graft from an HbsAg+ donor. HbsAg was not detected in the serum after BMT in 2/11 (18.2%) autologous BMT patients.

CONCLUSIONS

Hepatitis B virus carriers receiving a marrow graft from an HbsAg+ donor have a significantly increased risk of FH.

摘要

背景

骨髓移植（BMT）是治疗多种血液系统疾病的有效方法，但在乙肝病毒携带者高发人群中进行时，预计肝功能损害和暴发性肝炎（FH）的发生率会升高。

方法

43例乙肝病毒携带者接受了大剂量化疗和BMT，32例患者接受了异基因移植，11例患者接受了自体骨髓移植。急性移植物抗宿主病的预防措施包括在第1、3、6和11天使用甲氨蝶呤以及使用环孢素6个月。

结果

中位随访期为68个月（范围：1 - 11.5年）后，26例（81.3%）异基因BMT患者出现肝功能损害（LF），5例分别在第93、169、170、180和468天进展为FH，并在平均13.8天（范围：1 - 45天）后死亡。而只有4例（36.4%）自体BMT患者出现LF损害，无一例发生FH。LF损害（P = 0.026，卡方检验）和FH（优势比 = 12.86，系数P = 0.009）与异基因骨髓移植显著相关，且肝功能损害的时间与停用环孢素一致。在接受来自乙肝表面抗原（HbsAg）阳性供体骨髓移植的14例患者中，4例（28.6%）血清中的HbsAg消失。在2例（18.2%）自体BMT患者的BMT后血清中未检测到HbsAg。