Lau George K K, He Ming-Liang, Fong Daniel Y T, Bartholomeusz Angeline, Au Wing-Yan, Lie Albert K W, Locarnini Stephen, Liang Raymond
Division of Gastroenterology and Hepatology, University of Hong Kong, Hong Kong Special Administrative Region, China.
Hepatology. 2002 Sep;36(3):702-9. doi: 10.1053/jhep.2002.35068.
Exacerbation of hepatitis B virus (HBV) is a serious cause of morbidity and mortality in hepatitis B surface antigen (HBsAg)-positive patients undergoing transplantation. Our aim was to evaluate the effectiveness of lamivudine to prevent hepatitis due to exacerbation of HBV in HBsAg-positive patients treated with allogeneic hematopoietic cell transplantation. We studied 20 consecutive HBsAg-positive recipients of allogeneic hematopoietic cell transplantation who received lamivudine 100 mg daily starting one week before transplantation until week 52 after transplantation (group 1). Serial serum alanine aminotransferase and HBV DNA levels were measured before and after transplantation at 4- to 8-week intervals for the first year and then 4- to 12-week intervals. Their virologic and clinical outcomes were compared with 20 case-matched recipients who did not receive any antiviral therapy to HBV (anti-HBV) before and after hematopoietic cell transplantation (group 2). After transplantation, 9 patients (45%) in group 2 and one patient (5%) in group 1 had hepatitis due to exacerbation of HBV (P <.008), with 3 hepatic failures in group 2 and none in group 1. The one-year actuarial probability of survival without hepatitis due to exacerbation of HBV was higher in group 1 than group 2 (94.1% vs. 54.3%, P =.002). By multivariate Cox analysis, preemptive use of lamivudine effectively reduced hepatitis due to exacerbation of HBV (adjusted hazards ratio, 0.09; P =.021). In conclusion, preemptive lamivudine reduced HBV exacerbation. The use of lamivudine with other immunosuppressive regimens to prevent exacerbation of HBV should be further explored.
乙型肝炎病毒（HBV）再激活是接受移植的乙型肝炎表面抗原（HBsAg）阳性患者发病和死亡的严重原因。我们的目的是评估拉米夫定在预防接受异基因造血细胞移植的HBsAg阳性患者因HBV再激活所致肝炎方面的有效性。我们研究了20例连续接受异基因造血细胞移植的HBsAg阳性受者，他们从移植前一周开始每天服用100mg拉米夫定，直至移植后第52周（第1组）。在移植前后的第一年，每隔4至8周测定血清丙氨酸氨基转移酶和HBV DNA水平，之后每隔4至12周测定一次。将他们的病毒学和临床结局与20例在造血细胞移植前后未接受任何抗HBV病毒治疗（抗HBV）的病例匹配受者进行比较（第2组）。移植后，第2组有9例患者（45%）因HBV再激活发生肝炎，第1组有1例患者（5%）发生肝炎（P<0.008），第2组有3例肝衰竭，第1组无肝衰竭。第1组无HBV再激活所致肝炎的一年精算生存率高于第2组（94.1%对54.3%，P=0.002）。通过多变量Cox分析，预防性使用拉米夫定可有效降低因HBV再激活所致肝炎（校正风险比，0.09；P=0.021）。总之，预防性使用拉米夫定可减少HBV再激活。拉米夫定与其他免疫抑制方案联合使用预防HBV再激活的应用值得进一步探索。
