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看到一份比较移植术后采取乙免+抗病毒药和单独用抗病毒药的研究报告：
1. 乙免+抗病毒药比单独用抗病毒药1年，3年生成期高，5年生成期反而低。长期效果基本没有什么不同。
2. 移植前乙肝病毒DNA滴度是否正常是乙肝复发最重要因素：乙肝DNA病毒阴性，乙免+抗病毒药和单独用抗病毒药一样，二组病人无人复发。
3. 移植前乙肝DNA病毒阳性病人，乙免+抗病毒药能降低复发风险
4. 重点是新抗病毒药和移植前乙肝病毒DNA滴度
研究由于样本人数限制，仅供各位参考，下面是英文摘要。
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Thus we conducted this meta-analysis to compare antiviral drugs therapy with combined antiviral drugs and HBIG therapy for the prophylaxis of hepatitis B recurrence after LT. We aim to clarify whether it is necessary to use HBIG in liver transplant recipients with HBV related diseases. Compared with previous studies, we also focused on the application of new nucleoside antiviral drugs and patients pre-transplant HBV-DNA status. Since we mainly compared between antiviral drugs therapy with or without long-term combination of HBIG, intro-operative usage of HBIG was not taken into consideration in our comparison. Antiviral drugs therapy following a period of combination therapy was also regarded as a monotherapy strategy [20], [23], [25], [29]. As shown in this meta-analysis, combination therapy has a significant advantage in terms of HBV recurrence and the virus mutation. It can also improve the 1 year and 3 year survival of the patients, although no significant improvement in patients' long-term survival has been observed.
One-year, 3-year and 5-year patient survival rate were analyzed (Fig. 4). Six trials calculated the 1-year patients' survival rate in 346 cases. 101 patients in antiviral drugs therapy group showed a 90.1% 1-year survival rate, and 245 patients in combination therapy group had a 96.3% 1-year survival rate. 3-year patient survival rates were counted in 4 reports involving 270 patients, which were 71.6% and 86.7% for patients in antiviral drugs therapy group and combination therapy group respectively. 111 patients' 5-year survival rates were reported in 3 trials. 82.7% patients in antiviral drugs therapy group survived longer than 5 years, while in combination therapy group, the 5-year survival rate was 72.9%.
Patients' pre-transplant virus replication status has been documented as the most important risk factor for virus recurrence and virus mutation; HBV DNA has always been regarded as a representative for HBV replication status [29], [35], [38]. In patients with negative pre-transplant HBV DNA, the risk of virus recurrence is much lower [35], [38]. Neff [38] reported that no additional advantage was conferred by combined use of LAM and HBIG compared with LAM monotherapy in patients with negative pre-transplant HBV DNA. In his study, 33 and 18 patients with negative HBV DNA received LAM alone and LAM+HBIG respectively had no HBV recurrence.
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We conclude that the use of HBIG is necessary to decrease the risk of HBV recurrence in comparison to LAM monotherapy for liver recipients with positive HBV DNA before LT.
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发表于 2016-7-14 23:31:34
发表于 2016-7-15 15:09:08
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