供者HBV感染对异基因造血干细胞移植受者的影响
Clinical observation of influences of donor HBV infection on allogeneic hematopoietic stem cell transplantation recipients

摘要：目的 观察供者乙肝病毒(HBV)感染对异基因造血干细胞移植受者的影响。方法 回顾性分析我院2015年1月至2016年12月期间行异基因造血干细胞移植的4例非乙肝患者，其供者均有HBV感染。观察应用HBV感染供者的外周血造血干细胞进行移植，移植后对受者造血重建、肝静脉闭塞病(VOD)以及HBV感染的影响。结果 4例供者中2例供者为乙肝血清学HbsAb、HbeAb及HbcAb阳性，HBV-DNA定量阴性，供受者均未应用抗HBV药物。1例供者为HbsAg、HbeAb及HbcAb阳性，HBV-DNA定量阳性；1例供者HbsAg及HbcAb阳性，HBV-DNA定量阳性。这2例供者移植前1个月开始口服核苷类药物治疗，移植前HBV-DNA定量转为阴性，受者预处理前1周开始口服核苷类药物预防HBV感染，回输干细胞当天及回输后第3天及第7天均给予乙肝免疫球蛋白，移植后每月复查HbsAb定量，低于150IU给予输注乙肝免疫球蛋白。4例患者移植后均造血重建，无1例发生VOD，截止随访结束均无HBV感染，监测HBV-DNA定量阴性。结论 对于HBV复制的供者及其受者口服核苷类抗HBV药物联合乙肝免疫球蛋白可以有效预防受者HBV感染。
ABSTRACT: Objective To investigate the influences of donor HBV infection on allogeneic hematopoietic stem cell transplantation recipients. Methods We made a retrospective analysis of data of four patients without HBV infection who underwent allogeneic hematopoietic stem cell transplantation from January 2015 to December 2016. Among them donors of these patients all had HBV infection. We then observed the influences of HBV infection on hematopoietic reconstruction, hepatic vein occlusive disease and HBV infection. Results HBV serological conditions of two donors were HbsAb, HbeAb and HbcAb positive, and quantitative of HBV-DNA was negative; the donor and the recipient did not use anti-HBV drugs. One donor was HbsAg, HbeAb and HbcAb positive, and the quantitative of HBV-DNA was also positive. Another donor was HbsAg and HbcAb positive, and the quantitative of HBV-DNA was also positive. These two donors received oral nucleoside therapy one month before stem cell collection and the recipients of these two donors also took nucleoside drugs one week before the conditioning. Hepatitis B immune globulin was given after transfusion of stem cells and the third day and seventh day after transplantation. Quantitative of HbsAb was detected each month and if it was less than 150 IU, hepatitis B immune globulin would be given. All the recipients had hematopoietic reconstruction and no VOD or hepatitis B virus infection occurred. Conclusion Oral administration of nucleoside drugs combined with hepatitis B immunoglobulin can effectively prevent HBV infection in recipients with HBV infection donors