Chen P M, Fan S, Liu J H, Chiou T J, Hsieh S R, Liu R S, Tzeng C H
Department of Internal Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
Int J Hematol. 1993 Oct;58(3):183-8.
We report two cases of hepatitis B virus reactivation following allogeneic bone marrow transplantation (BMT) for severe aplastic anemia and acute myelocytic leukemia. The presence of antibodies to HBsAg, HBeAg and HBcAg prior to transplant indicated previous infection with hepatitis B virus (HBV). These antibodies disappeared 2 and 4 months after the onset of chronic graft versus host disease (GVHD) following immunosuppressive treatment, but HBsAg reappeared in their sera 6 and 10 months later, respectively. This suggests that chronic GVHD and immunosuppressive drugs can reactivate HBV in HBsAb-positive patients, most likely because of the decrease in quality and function of helper T cells and B cells during chronic GVHD to induce clearance of HBV antibodies and reactivation of HBV. Our observation confirms that patients with HBsAb, HBeAb and HBcAb present in their sera should not be considered to have 'immunity' to HBV after BMT.
我们报告了两例在接受异基因骨髓移植（BMT）治疗严重再生障碍性贫血和急性髓细胞白血病后发生乙型肝炎病毒再激活的病例。移植前存在针对乙肝表面抗原（HBsAg）、乙肝e抗原（HBeAg）和乙肝核心抗原（HBcAg）的抗体，表明既往感染过乙型肝炎病毒（HBV）。这些抗体在免疫抑制治疗后慢性移植物抗宿主病（GVHD）发作2个月和4个月后消失，但分别在6个月和10个月后其血清中再次出现HBsAg。这表明慢性GVHD和免疫抑制药物可使HBsAb阳性患者体内的HBV再激活，最可能的原因是慢性GVHD期间辅助性T细胞和B细胞的质量和功能下降，从而导致HBV抗体清除及HBV再激活。我们的观察结果证实，血清中存在HBsAb、HBeAb和HBcAb的患者在BMT后不应被视为对HBV具有“免疫力”。
