Lo Chung Mau, Liu Chi Leung, Chan See Ching, Lau George K, Fan Sheung Tat
Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.
J Hepatol. 2005 Aug;43(2):283-7. doi: 10.1016/j.jhep.2005.03.013.
BACKGROUND/AIMS: Lamivudine prophylaxis against hepatitis B virus (HBV) reinfection after liver transplantation is associated with recurrence due to escape mutants.
Fifty-two patients on lamivudine prophylaxis at a median of 412 days (median, 370-2040 days) after transplantation for chronic HBV-related liver disease received two courses of an accelerated schedule of double-dose recombinant HBV vaccine. Before vaccination, all patients were seronegative for HBsAg, anti-HBs and HBV DNA (by qPCR). Three intramuscular doses of vaccine (40 microg each) were administered monthly and another identical course was repeated after 3 months. Lamivudine (100mg/day) was continued throughout the study.
After the first course, two patients developed a weak response (anti-HBs titre of 12 mIU/mL) that disappeared rapidly. One early responder developed anti-HBs (27 mIU/mL) again after the second course but the other did not. Two other patients developed response (anti-HBs titre of 17 and 103 mIU/mL, respectively) giving an overall response rate of 7.7%. The antibody level declined rapidly. At the end of the study, one patient who did not respond had developed viral breakthrough which was treated with adefovir dipivoxil therapy.
Active immunization with two courses of double-dose recombinant HBV vaccine has limited efficacy in patients receiving lamividine prophylaxis after liver transplantation.
背景/目的：肝移植后使用拉米夫定预防乙型肝炎病毒（HBV）再感染与因逃逸突变体导致的复发有关。
52例因慢性HBV相关肝病接受肝移植的患者，在移植后中位时间412天（中位数，370 - 2040天）接受拉米夫定预防治疗，接受了两个疗程的加速双倍剂量重组HBV疫苗接种方案。在接种疫苗前，所有患者的HBsAg、抗-HBs和HBV DNA（通过定量聚合酶链反应）均为血清学阴性。每月肌肉注射三剂疫苗（每剂40微克），3个月后重复相同疗程。在整个研究过程中持续使用拉米夫定（100毫克/天）。
第一个疗程后，两名患者产生了微弱反应（抗-HBs滴度为12 mIU/mL），但反应迅速消失。一名早期应答者在第二个疗程后再次产生抗-HBs（27 mIU/mL），但另一名没有。另外两名患者产生了反应（抗-HBs滴度分别为17和103 mIU/mL），总体反应率为7.7%。抗体水平迅速下降。在研究结束时，一名无反应的患者发生了病毒突破，接受了阿德福韦酯治疗。
两疗程双倍剂量重组HBV疫苗主动免疫对肝移植后接受拉米夫定预防治疗的患者疗效有限。
