Hepatitis B immune globulin: the US experience.
Hepatitis B immune globulin: the US experience.
复制标题
乙型肝炎免疫球蛋白：美国的经验。
作者：
T. Pruett;R. McGory
随着B型肝炎免疫球蛋白（HBIg）在B型肝炎患者肝移植中的广泛应用，降低了同种异体移植物感染的发生率，使肝移植术的效果得到了很大的改善。在这篇文章中，主要的美国研究使用HBIg的审查，包括临床结果，临床失败和问题，以及剩余的信息仍然需要最佳的治疗。这些研究产生了几个主要的临床发现。(1)随着高剂量的HBIg和持续使用这种药物，有可能预防B病毒DNA阳性患者的复发。(2)很难预测移植后所需的HBIg剂量或同种异体移植物中B型肝炎的复发。(3)虽然HBIg被动免疫可以帮助乙型肝炎B型肝硬化患者成功移植，但有两种典型的失败模式：早期围手术期同种异体移植物感染野生型乙型肝炎B病毒，以及移植后6个月以上感染突变病毒。这些问题似乎只出现在移植前病毒复制的患者中。(4)HBIg和拉米夫定的联合治疗有望进一步改善肝移植的效果。(5)关于联合治疗策略仍有一些未解之谜：最佳时机、患者选择、治疗持续时间以及病毒突变和不良事件的风险。此外，改变免疫抑制方案在改善B型肝炎感染患者移植中的作用尚未确定。
The increasingly aggressive use of hepatitis B immune globulin (HBIg) in liver transplantation for hepatitis B infected patients has led to a great improvement in this procedure by lowering the incidence of allograft infection. In this article, major US studies on the use of HBIg are reviewed, including clinical results, clinical failures and problems, and the remaining information still needed for optimal therapy. Several major clinical findings have resulted from these studies. (1) With a high dose of HBIg and continuous use of this agent, it is possible to prevent recurrence in hepatitis B virus DNA-positive patients. (2) It is difficult to predict the required post-transplant dose of HBIg or the recurrence of hepatitis B in allografts. (3) While passive immunization of HBIg can help achieve successful transplants of patients suffering from hepatitis B cirrhosis, there are two typical patterns of failure: allograft infection with wild-type hepatitis B virus in the early perioperative period and with a mutant virus more than 6 months post-transplantation. These problems appear to arise only in patients with pre-transplant viral replication. (4) Combination therapy of HBIg and lamivudine seems promising for further improvement of liver transplantation. (5) There are still unanswered questions concerning the combination strategy: optimal timing, patient selection, duration of therapy, and the risk of viral mutations and adverse events. In addition, the role of changing immunosuppression protocols in improving transplantation of hepatitis B infected patients has not been determined.