伊马替尼治疗慢性髓性白血病引起乙型肝炎病毒再激活二例报道并文献复习  

Reactivation of chronic hepatitis B infection related to imatinib mesylatetherapy in patients with chro- nic myeloid leukemia： two cases report and literatures review

作　　者：王雅丹[1] 崔国惠[1] 游泳[1] 李勉[1] 夏佳[1] 胡豫[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院血液病研究所,武汉430022

出　　处：《中华血液学杂志》2012年第9期743-746,共4页Chinese Journal of Hematology

摘　　要：目的探讨长期服用伊马替尼触发乙型肝炎病毒（HBV）再激活的可能原因及其可能的监控管理措施。方法报道2例服用伊马替尼过程中出现HBV再激活的慢性髓性白血病（CML）患者，并针对发生机制、治疗预防相关措施进行文献复习。结果2例HBsAg阳性、肝功能正常的CML患者，在服用伊马替尼过程中出现一过性的HBV再激活。经过抗病毒药物和伊马替尼联合治疗，最终获得良好转归。结论对于长期服用伊马替尼是否会导致病毒再激活问题上仍存在众多争议，鉴于已有相关病例报道，建议所有CML患者在伊马替尼治疗前，均进行HBV血清学筛查。只要HBsAg阳性，就应该预防性抗病毒治疗，并监测血清学、病毒学和生化指标。Objective To probe the cause for triggering HBV reactivation and possible management of the chronic hepatitis B individuals received imatinib. Methods This study presented two cases of transient hepatitis B virus （HBV） reactivation and hepatic dysfunction during oral imatinib for chronic myeloid leuke- mia （CML） and made a literatures review about the pathogenesis, possible prophylactic and therapeutic man- agement of such chronic hepatitis B individuals receiving imatinib. Results Two CML patients, without prior liver dysfunction but with chronic HBV infection, suffered from transient HBV reactivation occurred during o- ral imatinib. Both of them finally obtained good outcome following the additional oral nucleotide antiviral ther- apy. Conclusion It remained unclear whether imatinib induced the reactivation of HBV in patients with a la- tent HBV infection. From our study, all candidates receiving oral imatinib should be screened for HBsAg and anti-HBc antibodies prior to initiation of imatinib. Prophylactic antiviral therapy should be offered to HBV-in- fected individuals along with a close monitoring for signs of reactivation.

关 键 词：乙型肝炎病毒 再激活 伊马替尼 白血病 髓样 慢性 

分 类 号：R733[医药卫生—肿瘤] R51[医药卫生—临床医学]