目的

评价恩替卡韦联合乙肝免疫球蛋白（HBIG）预防原位肝移植（OLT）术后HBV再感染的效果，探讨HBV复发高危患者的预防策略。

方法

对具有肝移植术后HBV再感染高危因素的患者，采用双向型的队列研究。试验组：前瞻性研究从2006年3月至2007年6月行同种异体原位肝移植术患者，术后长期使用恩替卡韦+肌注型HBIG预防HBV再感染；对照组：回顾性分析2003年9月至2006年3月行同种异体原位肝移植术的患者，术后长期使用拉米夫定+肌注型HBIG。两组患者观察截止到2008年3月，对HBV DNA定量水平、乙肝两对半、HBV再感染时间、累积再感染率进行统计学分析。

结果

试验组38例患者，随访时间（18.5±5.3）个月，未发现HBV再感染；对照组共116例患者，随访时间（20.2±9.8）个月，其中15例出现了HBV再感染，再感染率为12.9%，再感染时间为（18.9±8.7）个月，两组差异有统计学意义。对两组患者累积再感染率行Kaplan-Meier法分析提示两组患者累积再感染率曲线有统计学意义，试验组的累积再感染率低于对照组（0 vs 12.93%,P＜0.05）。

结论

对具有HBV再感染高危因素的患者，恩替卡韦联合HBIG与拉米夫定联合HBIG相比，有效地降低了肝移植术后HBV再感染率。

Objective

To investigate the availability of entecavir and hepatitis B virus immunoglobulin(HBIG)on the immunoprophylaxis of the HBV recurrence after orthotopic liver transplantation(OLT)with high risks of HBV reinfection.

Methods

Two-way cohort study was adopted in our trial.38 patients,who underwent liver transplantation in our center from March 2006 to June 2007,were followed up prospectively with the combination of intramuscular hepatitis B virus immunoglobulin and entecavir.116 patients,who underwent liver transplantation from September 2003 to March 2006,were analyzed retrospectively with the combination of intramuscular hepatitis B virus immunoglobulin and Lamivudine as the prophylaxis for HBV reinfection.HBV markers in serum,HBV DNA,the cumulative recurrence were analyzed.

Results

Entecavir group,in the follow-up period of （18.5±5.3）months,had been traced no HBV recurrence.However,15 petients had been traced for (18.93±8.56)months in lamivudine group.The rate of HBV recurrence in entecavir group was lower than in lamivudine group(0 vs 12.93%, P＜0.05). The cumulative recurrence of entecavir group was lower than that of Lamivuding group.

Conclusion

Combination ofentecavir and intramuscular HBIG as the prophylaxis of HBV reinfection is more effective than the lamivudine and intramuscular HBIG group,especially to the patients with the high risks of HBV recurrence.