【摘要】 目的:探讨肝炎病毒对造血干细胞移植(HSCT)的影响。方法:回顾性分析我院21例肝炎病毒感染接受HSCT治疗的患者的临床资料。乙型肝炎病毒(HBV)感染18例,其中供受者同时有HBV感染4例,供者有HBV感染3例,受者有HBV感染11例,供者、受者移植前后服用拉米夫定预防和治疗HBV感染。丙型肝炎病毒(HCV)感染3例,均为受者感染,移植免疫恢复后给予α干扰素治疗。结果:HSCT后植活平均15(9～31)d。HSCT后发生急性移植物抗宿主病(GVHD)9例(47%),发生慢性GVHD7例(37%)。HSCT后无肝静脉闭塞症发生。HBV感染供者,HSCT后无爆发性乙型病毒性肝炎发生。1例(1/18)HBV感染患者HSCT后6个月停用拉米夫定而发生爆发性乙型病毒性肝炎。1例(1/18)受者HBsAg HBeAg HBcAb(+),供者HBsAb(+),HSCT3个月后患者HBsAb HBeAb HBcAb(+),HBV-DNA阴性。3例HCV感染患者HSCT后用α干扰素治疗,2例HCV-RNA转阴。结论:HBV感染的供受者,在行HSCT过程中,应用拉米夫定能够有效预防移植后乙型病毒性肝炎的复燃,丙型病毒性肝炎的患者应用干扰素治疗可使HCV-RNA转阴。初步认为,肝炎病毒感染可能并非是HSCT的禁忌症。更多还原

【Abstract】 Objective:To explore the effect of hepatitis virus infection on the outcome of hematopoietic stem cell transplantation (HSCT).Method:A retrospective analysis was conducted at the bone marrow transplant unit in our hospital. A total of 72 patients underwent HSCT,among them there were 21 patients with hepatitis virus infection. There were 18 patients with HBV infection included in the study. Among 18 cases,11 infected cases were recipients,3 infected cases were donors,4 cases were donors and recipients simultaneously infected. HBV infected patients were received lamivudine through HSCT. All 3 patients with HCV infection were recipients. After the process of HSCT,patients with HCV were treatmented with interferon. Result:The patients were followed up to the average of 36 months. The engraftment of HSCT was the average of 15 days (15-31 days). The cumulative incidence of acute graft versus host disease (aGVHD) was 45%. The cumulative incidence of chronic GVHD was 35%. After HSCT,in all the patients there was no incidence rate of hepatic veno-occlusive disease (HVOD). In those cases of donors infected with hepatitis B virus,recipients did not suffer from hepatitis B after HSCT. One patient suffered from hepatitis again due to reactivation of HBV,after withdrawing lamivudine 6 months after hematopoietic stem cell transplantation. In other case,one recipient infected with hepatitis B virus with HBsAg(+),HBeAg(+),HBcAb(+),and the donor was with HBeAb(+),the recipient turned with HBsAb(+),HBeAb(+),HBcAb(+) but HBV DNA (-) 3 months after HSCT. Three patients with HCV were treatmented with interferon and 2 of those patiens turned to be HCV-RNA negative. Conclusion:Prophylaxis with lamivudine in HBsAg positive donors and recipients underwent HSCT can reduce the reactivation of HBV. Adminstration interferon to patients with HCV underwent HSCT can induce HCV-RNA to negative. Donors and recipients infected with hepatitis virus were not contradictive to HSCT.更多还原