Brind A M, Bennett M K, Bassendine M F
Centre for Liver Research, School of Clinical Medical Sciences, Newcastle upon Tyne, UK.
Liver. 1998 Apr;18(2):134-9. doi: 10.1111/j.1600-0676.1998.tb00139.x.
A 45-year-old HBsAg carrier (HBeAb positive with normal liver function tests) underwent renal transplantation for mesangioproliferative glomerulonephritis. Sixteen months later he developed jaundice. Investigations showed he remained HBeAb positive, but HBV-DNA levels were 99 pg/ml, indicating active replication of a HBV pre-core mutant. He was commenced on lamivudine therapy with a subsequent rapid fall in HBV-DNA levels to 2.8 pg/ml, but liver function tests continued to deteriorate and he developed hepatorenal failure. Liver biopsy showed fibrosing cholestatic hepatitis. He underwent liver transplantation, which was complicated by lactic acidosis. Lamivudine was withdrawn and HBV prophylaxis with HB immunoglobulin was commenced. Unfortunately he died 38 days post-transplant of surgical complications with no evidence of HBV recurrence. We discuss the use of nucleoside analogues in fibrosing cholestatic hepatitis and review the literature.
一名45岁的乙肝表面抗原携带者（乙肝e抗体阳性，肝功能检查正常）因系膜增生性肾小球肾炎接受了肾移植手术。16个月后，他出现了黄疸。检查显示他仍为乙肝e抗体阳性，但乙肝病毒DNA水平为99 pg/ml，表明乙肝前C区突变体处于活跃复制状态。他开始接受拉米夫定治疗，随后乙肝病毒DNA水平迅速降至2.8 pg/ml，但肝功能检查仍持续恶化，他发展为肝肾衰竭。肝活检显示为纤维淤胆型肝炎。他接受了肝移植手术，术后出现了乳酸酸中毒并发症。停用拉米夫定，并开始使用乙肝免疫球蛋白进行乙肝预防。不幸的是，他在移植后38天因手术并发症死亡，未发现乙肝复发迹象。我们讨论了核苷类似物在纤维淤胆型肝炎中的应用，并回顾了相关文献。
