【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(χ~2=1.525,P=0.466)、受者生存率(Log-rank χ~2=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。更多还原

【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.ResultsThe 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(χ~2=1.525, P=0.466), and recipient survival rates between three groups(Log-rank χ~2=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.ConclusionThe graft type and intraoperative plasma transfusion influence the decline of HBsAb titer after transplantation.更多还原