【摘要】 目的 观察拉米夫定对免疫受损宿主HBV再激活的预防和治疗作用。方法 将HBsAg阳性免疫受损宿主分为两组：拉米夫定预防组和对照组；预防组在使用免疫抑制剂或细胞毒性化疗之前2～3周开始使用拉米夫定0.1g口服1次/d，进行预防性治疗，对照组在宿主出现HBV再激活表现时开始用相同剂量进行治疗，分别于拉米夫定治疗后或免疫抑制治疗开始后2周、4周、6周、12周、24周检测肝功、HBVM及HBV病毒定量。结果 拉米夫定预防组在使用免疫抑制剂或细胞毒性药物过程中或结束后，18.5%(3/16)出现HBV再激活表现；对照组53%(7/13)出现HBV再激活，拉米夫定治疗后71.4%(5/7)病毒转阴，肝功恢复正常，其中2例死于暴发性肝衰竭。结论 早期应用拉米夫定可有效预防及治疗免疫受损宿主HBV再激活。

    关键词 HBV再激活 拉米夫定 HBsAg携带者

    Therapy and prevention effect of lamivudine on HBV reactivation in HBV carrier with immuno default

    Liang Xuesong,Wan Mobin,Chen Jixiu,et al.

    Department of Infection,Changhai Hospital Affliated to The Second Military Medical University,Shanghai 200433.

    【Abstract】 Objective To test the therapy and prevention effect of lamivudine on HBV reactivation in HBV carrier with immuno default.Methods Randomly divided the patients into two group,one group had 20 patients and the patients were treated with lamivudine 2～3 weeks before cytotoxic therapy or immuno-inhibitor therapy.The control was not treated with lamivudine until occurring HBV reaction during cytotoxic therapy.Liver function level and serum HBV RNA level of all patients were examined respectively at the end of 2w,4w,6w,12w and 24w after therapy with Lamivudine or beginning cytotoxic therapy.Results In lamivudine preventive therapy group,18.5%(3/16)were protected from HBV reaction during cytotoxic therapy or immuno-inhibitor therapy,in control,53%(7/13)occurred HBV reaction during or after cytotoxic therapy,patients with HBV reaction were treated with lamivudine and 71.4%(5/7)appeared serum load decrease and liver function normal,only one patient died of liver failure.Conclusion Early usage of lamivudine could effectively protect HBV carriers against chemotherapy-induced hepatic failure. ......