3 问题的解决
①明确了肝移植术后乙型肝炎复发的病因：主要与慢性乙型肝炎病毒 DNA 水平、肝外组织慢性乙型肝炎病毒入侵、免疫抑制治疗、病毒基因变异等因素有关。②国内肝移植术后慢性乙型肝炎病毒再感染的主要防治方案是联合应用乙型肝炎免疫球蛋白与拉米夫定，既经济又取得了良好的治疗效果；但长期应用拉米夫定会出现慢性乙型肝炎病毒聚合酶YMDD 基因序列变异，导致乙型肝炎复发。③术后乙型肝炎复发与YMDD 变异的预防方案包括：a.术前应用拉米夫定。b.供体安全。c.应用拉米夫定超过半年者，应每3 个月检测1 次病毒变异。d.合理用药。e.接种乙型肝炎疫苗。治疗方案包括：a.对症支持治疗。b.再次肝移植。c.调整拉米夫定剂量。d.阿地福韦等药物可作为YMDD 变异的补救治疗方法。
4 参考文献
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