拉米夫定预防乙型肝炎病毒再激活的临床分析  

Lamivudine as prophylaxis for the reactivation of hepatitis B virus in immunosuppressed patients

作　　者：任慧琼[1] 闻炳基[2] 王月兰[1] 徐赛芳[1] 张化好[1] 

机构地区：[1]上海解放军第八五医院感染科,200235 [2]解放军第一一三医院肿瘤科

出　　处：《肝脏》2011年第5期377-379,共3页Chinese Hepatology

摘　　要：目的探讨使用免疫抑制剂和(或)细胞毒性化疗药物的乙型肝炎病毒(HBV)感染者HBV再激活的发生率及其抗病毒治疗的疗效。方法预防组33例患者在接受免疫抑制剂和(或)细胞毒性化疗药物治疗前予拉米夫定(LAM)100mg/d并持续至治疗结束后6个月,对照组39例未接受预防治疗,观察两组患者HBV再激活的发生率和临床表现。统计学分析采用两种属性独立性x^2检验,进行危险比评估。结果预防组HBV再激活发生率为12.12%(4/33),对照组为76.92%(30/39),预防组HBV再激活发生率低于对照组,x^2=10.35,P=0.001,差异有统计学意义;对照组HBV再激活后患者死亡率、肝炎发生率高于预防组,差异有统计学意义;两组药物性肝损伤、重型肝炎的发病率差异无统计学意义,对照组中有9例进展为重型肝炎,均死亡。结论使用免疫抑制剂和(或)细胞毒性化疗药物的HBV感染者预防性使用LAM可以有效防止HBV再激活,降低病死率。所有需要使用免疫抑制剂和(或)化疗药物的患者在用药前须进行常规HBV筛查。Objective To investigate the efficacy of lamivudine （LAM） as a prophylactic agent against the reactivation of hepatitis B virus（HBV） in patients with HBV infection and undergoing immunosuppressive therapy and/or chemotherapy,and to evaluate the role of LAM against HBV reactivation. Methods Thirty-three patients of the preventive group received LAM as a prophylactic agent before immunosuppressive and/or chemotherapy. Thirty-nine patients of the control group were enrolled in the study. The characteristics of HBV reactivation were investigated. Results After chemotherapy and/or immunosuppressive treatment, only 12. 12% （4/33）of the preventive group were suffered from HBV reactivation. Nine patients in the control group were dead of liver failure. Conclusion HBV can be activated in cytotoxic chemotherapy and/or immunosuppressed patients. LAM should be used in early phase to prevent HBV reactivation.

关 键 词：乙型肝炎病毒 免疫抑制剂 化学治疗 再激活 拉米夫定 

分 类 号：R512.62[医药卫生—内科学]