Tillmann H L, Hadem J, Leifeld L, Zachou K, Canbay A, Eisenbach C, Graziadei I, Encke J, Schmidt H, Vogel W, Schneider A, Spengler U, Gerken G, Dalekos G N, Wedemeyer H, Manns M P
Medical Clinic and Policlinic II, University Leipzig, Germany.
J Viral Hepat. 2006 Apr;13(4):256-63. doi: 10.1111/j.1365-2893.2005.00695.x.
Acute hepatitis B progresses to liver failure with the need of liver transplantation in about 1% of cases. We treated patients with severe acute or fulminant hepatitis B with lamivudine in an attempt to prevent hepatitis B virus (HBV) reinfection after potential liver transplantation. Since September 2000, 17 patients with severe acute or fulminant HBV infection were treated with 100 or 150 mg lamivudine daily once we had evidence for a severe course as indicated by an INR >2.0. These were compared to a historic control from our unit and to external patients. Fourteen of the 17 patients (82.4%) survived with full recovery without liver transplantation. All these 14 individuals cleared HBsAg on lamivudine within less than 6 months. Twelve patients recovered quickly as indicated by a normalized prothrombin time within 1 week while two patients had a more prolonged course. None of the patients showed an adverse event. Three patients requiring transplantation despite lamivudine therapy had more advanced disease on admission, of whom one had additionally ingested paracetamol (acetaminophen) while the second was already HBV-DNA negative by polymerase chain reaction on admission. The lamivudine treated patients had significant higher frequency of survival without liver transplantation 82.4 vs 20% (4/20) in the historic control (P < 0.001). Similar data were derived from external centres using lamivudine (15/20, 75%). Lamivudine is safe in patients with severe acute or fulminant hepatitis B, leading to fast recovery with the potential to prevent liver failure and liver transplantation when administered early enough.
约1%的急性乙型肝炎会进展为肝衰竭并需要进行肝移植。我们用拉米夫定治疗重症急性或暴发性乙型肝炎患者，试图预防潜在肝移植后乙型肝炎病毒（HBV）再感染。自2000年9月起，一旦国际标准化比值（INR）>2.0表明病情严重，就对17例重症急性或暴发性HBV感染患者每日给予100或150毫克拉米夫定治疗。将这些患者与我们科室的历史对照患者以及外部患者进行比较。17例患者中有14例（82.4%）存活且完全康复，无需进行肝移植。所有这14例患者在使用拉米夫定后不到6个月内HBsAg转阴。12例患者凝血酶原时间在1周内恢复正常，恢复迅速，而2例患者病程较长。所有患者均未出现不良事件。尽管接受了拉米夫定治疗，但仍有3例患者需要进行移植，他们入院时病情更严重，其中1例还服用了对乙酰氨基酚，另1例入院时通过聚合酶链反应检测HBV-DNA已呈阴性。接受拉米夫定治疗的患者无需肝移植的存活频率显著更高，为82.4%，而历史对照患者为20%（4/20）（P<0.001）。使用拉米夫定的外部中心也得出了类似的数据（15/20，75%）。拉米夫定对重症急性或暴发性乙型肝炎患者安全，若早期给药可促使快速康复，并有可能预防肝衰竭和肝移植。
