实体肿瘤化疗中乙型肝炎病毒再激活的临床分析  

Hepatitis B Virus Reactivation in Patients with Solid Tumor Undergoing Chemotherapy

作　　者：杨琳[1] 肖志平[1] 蒋月强[2] 陈元[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肿瘤科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院老年科,湖北武汉430030

出　　处：《华南国防医学杂志》2012年第5期455-457,460,共4页Military Medical Journal of South China

基　　金：湖北省自然科学基金项目(2011CDB213)

摘　　要：目的观察实体肿瘤化疗中乙型肝炎病毒(hepatitis B virus,HBV)再激活的发生和转归,探讨其预防和处理方法。方法回顾性分析2011-01/2011-06月间作者医院接受化疗的实体肿瘤患者980例,对化疗前乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性患者,根据是否采用预防抗病毒治疗分为预防抗病毒治疗组(A组)、未预防抗病毒治疗组(B组),观察比较2组化疗后发生肝炎及HBV再激活的情况。结果 980例实体肿瘤患者中,在化疗前行乙型病毒肝炎5项检测者152例(15.5%),行HBV-DNA检测者72例(7.3%),HBsAg阳性患者42例,A组13例,B组29例,既往乙型肝炎病毒感染者82例。HBsAg阳性患者中化疗后发生肝炎者A组5例(38.5%),B组19例(65.5%);发生HBV再激活者A组0例,B组8例(27.6%),1例患者死于爆发性肝炎,2组间比较有统计学差异(P=0.043)。结论HBsAg阳性的实体肿瘤患者化疗中,可能发生HBV再激活,甚至危及生命。预防性抗HBV治疗能有效减少HBV再激活发生,改善预后。Objective To observe the incidence and turnover of hepatitis B virus（HBV） reactivation in patients with solid tumor undergoing chemotherapy and investigate the prevention and treatment methods.Methods A total of 980 patients with solid tumors undergoing chemotherapy from January 2011 to June 2011 in our hospital were retrospectively analyzed.The patients with positive hepatitis B surface antigen（HBsAg） were divided into two groups,i.e.group A with nucleoside analogues prevention treatment and group B without prevention treatment.The incidence of hepatitis and HBV reactivation was compared between the two groups.Results In 980 patients with solid tumor undergoing chemotherapy,152 cases（15.5%） received HBsAg test,72 cases（7.3%） received HBV-DNA test,42 cases showed positive in HBsAg（13 in group A and 29 in group B）,and 82 patients were diagnosed with past infection of HBV.There were Five cases（38.5%） in group A and 19 cases（65.5%） in group B suffered from hepatitis.No patient in group A and 8 patients（27.6%） in group B suffered from HBV reactivation,and 1 patient died from hepatic failure.There was significant difference between two groups（P=0.043）.Conclusion HBV reactivation could occur in HBsAg positive patients with solid tumor undergoing chemotherapy,which may lead to death.Preventive use of nucleoside analogues can effectively reduce the incidence of HBV reactivation and improve the prognosis.

关 键 词：实体肿瘤 乙型肝炎病毒再激活 化疗 

分 类 号：R512.6[医药卫生—内科学]