天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (4): 356-359.doi: 10.11958/20190730

• 专题研究·胆道闭锁与肝移植 • 上一篇    下一篇

乙肝核心抗体阳性供肝应用于儿童肝移植的安全性评价

宋卓伦 1，2，高伟 1，2△，李静 3，董冲 1，2，陈静 1，2，马楠 1，2，孟醒初 1，2，孙超 1，2， 覃虹 1，2，韩潮 1，2，吴斌 1，2，王凯 1，2，沈中阳 1，2   

  1. 1天津市第一中心医院器官移植中心（邮编300192）；2天津市器官移植重点实验室；3天津市第一中心医院护理部
  • 收稿日期:2019-03-14 修回日期:2019-04-15 出版日期:2019-04-15 发布日期:2019-05-27
  • 通讯作者: 高伟 E-mail:gao-wei@medmail.com.cn
  • 作者简介:宋卓伦（1987），男，医师，主要从事肝脏移植方面研究
  • 基金资助:
    HBcAb阳性供肝应用于儿童肝移植受者可行性研究

The safety evaluation of hepatitis B virus core antibody-positive grafts in pediatric liver transplantation

SONG Zhuo-lun1,2, GAO Wei1,2△, LI Jing3, DONG Chong1,2, CHEN Jing1,2, MA Nan1,2, MENG Xing-chu1,2, SUN Chao 1,2, QIN Hong1,2, HAN Chao1,2, WU Bin1,2, WANG Kai1,2, SHEN Zhong-yang 1,2   

  1. 1 Organ Transplantation Center, Tianjin First Center Hospital, Tianjin 300192, China; 2 Tianjin Key Laboratory for Organ Transplantation; 3 Department of Nursing, Tianjin First Center Hospital
  • Received:2019-03-14 Revised:2019-04-15 Published:2019-04-15 Online:2019-05-27
  • Contact: Wei GAO E-mail:gao-wei@medmail.com.cn

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摘要： 目的 观察接受乙肝核心抗体（HBcAb）阳性供肝的儿童肝移植受者术后早期乙肝表面抗体（HBsAb）滴度 的衰减情况并分析其影响因素。方法 回顾性分析2016年9月—2017年12月在天津市第一中心医院儿童器官移植 中心完成的60例接受HBcAb阳性供肝的HBsAb滴度＞1 000 IU/L的儿童肝移植受者。根据术后3个月间HBsAb滴 度变化情况将受者分为3组：A组HBsAb滴度仍>1 000 IU/L，18例；B组HBsAb滴度200~1 000 IU/L，18例；C组HBsAb 滴度<200 IU/L，24例。比较3组病例供受者信息、围手术期资料、术后并发症、术后新发乙肝病毒（HBV）感染情况以 及移植物和受者生存率。运用 Logistic分析受者术后早期 HBsAb滴度衰减的影响因素。结果 60例患者中位随访 时间为 17.8个月，随访期内 C组 1例患者死于间质性肺炎，1例出现新发 HBV感染，其余 2组患者随访期内未见死亡 和新发 HBV感染病例。3组患者术后新发 HBV感染发生率（χ2=1.525，P=0.466）、受者生存率（Log-rank χ2=1.665，P= 0.625）差异无统计学意义。Logistic回归结果显示，接受儿童器官捐献肝移植（OR=10.82，95%CI：1.17~100.50）、术中 血浆输注量≥400 mL（OR=6.25，95%CI：1.51~25.87）是术后 HBsAb滴度衰减的危险因素。结论 移植物类型和术中 血浆输注量影响受者术后HBsAb滴度衰减程度。

关键词: 肝移植, 儿童, 乙型肝炎, 乙型肝炎核心抗体, 乙型肝炎表面抗体

Abstract: Objective To observe the decline of post-operative hepatitis B virus surface antibody (HBsAb) titer and evaluate its influential factors in pediatric recipients receiving hepatitis B core antibody (HBcAb) positive grafts. Methods Sixty recipients who were operated in Tianjin First Center Hospital from September 2016 to December 2017 were enrolled in the study. The recipients were divided into three groups according to the changes of HBsAb titer three months after liver transplantation: group A (HBsAb titer > 1 000 IU/L, n=18), group B (200 IU/L ≤ HBsAb titer ≤ 1 000 IU/L, n=18) and group C (HBsAb titer < 200 IU / L, n=24). The donor and recipient characteristics, peri-operative data, post-operative complications, de novo hepatitis B along with graft and recipient survival rates were compared between three groups. Logistic analysis was used to analyze the influencing factors for HBsAb titer decline. Results The median follow-up time was 17.8 months for all recipients. One patient died of interstitial pneumonia in group C. One patient developed de novo hepatitis B in group C. No cases of recipient death and de novo hepatitis B in group A and B. There were no differences in de novo hepatitis B (χ2=1.525, P=0.466), and recipient survival rates between three groups (Log-rank χ2=1.665, P=0.625). Recipients receiving living-related grafts (OR=10.82, 95%CI: 1.17-100.50) and more than 400 mL plasma transfusion during operation (OR=6.25, 95%CI: 1.51-25.87) were risk factors for the decline of HBsAb titer after operation. Conclusion The graft type and intraoperative plasma transfusion influence the decline of HBsAb titer after transplantation.

Key words: liver transplation, child, hepatitis B, hepatitis B core antibody, hepatitis B surface antibody