拉米夫定治疗异基因骨髓移植4年后乙肝血清学转换逆转。
Lamivudine treatment for reverse seroconversion of hepatitis B 4 years after allogeneic bone marrow transplantation.
作者信息
Hashino S, Nozawa A, Izumiyama K, Yonezumi M, Chiba K, Kondo T, Suzuki S, Hige S, Asaka M
机构信息
Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
出版信息
Bone Marrow Transplant. 2002 Feb;29(4):361-3. doi: 10.1038/sj.bmt.1703387.
Reverse seroconversion of hepatitis B virus (HBV) after allogeneic BMT is rare. We present a case of HBV reactivation late after allogeneic BMT which responded well to lamivudine therapy. A 35-year-old woman with CML received an allogeneic BMT. Before BMT, the patient had immunity to HBV, with serum antibodies against hepatitis B surface antigen (HBsAb), and the donor was completely negative for HBV. Four years after BMT, acute hepatitis occurred with a detectable level of HBV-DNA. Lamivudine rapidly reduced transaminase and bilirubin levels, and serum HBV-DNA decreased to negative. Retrospective analysis revealed that there had been a gradual decrease in serum HBsAb titers after BMT. Administration of lamivudine immediately after HBV replication may be more effective than vaccination of hepatitis B surface antigen-negative donors before BMT.
异基因骨髓移植后乙肝病毒（HBV）血清学转换逆转的情况较为罕见。我们报告了1例异基因骨髓移植后晚期HBV再激活的病例，该病例对拉米夫定治疗反应良好。一名35岁的慢性粒细胞白血病女性接受了异基因骨髓移植。骨髓移植前，患者对HBV具有免疫力，血清中有抗乙肝表面抗原抗体（HBsAb），且供体HBV检测完全阴性。骨髓移植4年后，出现急性肝炎，HBV-DNA水平可检测到。拉米夫定迅速降低了转氨酶和胆红素水平，血清HBV-DNA降至阴性。回顾性分析显示，骨髓移植后血清HBsAb滴度逐渐下降。在HBV复制后立即给予拉米夫定可能比在骨髓移植前对乙肝表面抗原阴性供体进行疫苗接种更有效。
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