肿瘤患者化疗时乙型肝炎病毒的再激活及核苷类药物的预防作用  

Reactivation of hepatitis B virus and antiviral treatment in cancer patients receiving chemotherapy

作　　者：刘瑶[1] 孔心涓[1] 姜英俊[2] 武军[1] 李新华[1] 田字彬[1] 

机构地区：[1]青岛大学医学院附属医院消化科,山东省青岛市266003 [2]青岛大学医学院附属医院急诊普外科,山东省青岛市266003

出　　处：《世界华人消化杂志》2013年第11期1050-1054,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨HBsAg阳性的恶性肿瘤患者化疗时乙型肝炎病毒(hepatitis B virus,HBV)的再激活及核苷类药物的预防作用.方法:分析在我院进行化疗且资料完整的恶性肿瘤患者2253例,筛选其中HBsAg阳性且肝功能正常的患者125例,其中88例仅单独给予化疗(对照组),37例化疗前1wk给予核苷类药物治疗(治疗组).比较两组化疗后HBV再激活、肝炎复发及化疗终止等的差异.结果:化疗前879例患者进行了HBV血清学检测(39.0%).125例HBsAg阳性患者中47例(37.6%)出现肝炎复发,其中治疗组和对照组分别为7例和40例(18.9%vs45.5%,P=0.008),重度肝炎在治疗组和对照组分别为2例和19例(5.4%vs21.6%,P=0.035),轻、中度肝炎两组比较无统计学意义(P>0.05).17例(13.6%)患者出现HBV再激活,治疗组和对照组分别为1例和16例(2.7%vs18.2%,P=0.022).延迟化疗在治疗组和对照组分别为3例和29例(8.1%vs33.0%,P=0.003).结论:预防性的抗病毒治疗能显著降低HBsAg阳性的肿瘤患者化疗时HBV的再激活,有助于减少化疗延迟.AIM： To investigate the reactivation of hepatitis B virus （HBV） and the effect of antiviral treatment in cancer patients receiving chemotherapy. METHODS： Clinical data for 2 253 cancer patients undergoing chemotherapy were reviewed. Of 125 patients who were positive for HBV surface antigen, 37 received antiviral treatment （therapy group） and 88 did not （control group）. These patients were followed for at least 6 mo afterthe completion of treatment. During the course of chemotherapy, liver function tests, viral load （HBV-DNA）, and HBV reactivation rate were determined on days 1 and 10 of each cycle. RESULTS： A total of 879 （39.0%） cancer patients were screened for HBV status. In 125 patients who were positive for HBV surface antigen, 47 （37.6%） developed hepatitis during chemotherapy. Of these 47 patients, 7 （18.9%） were included in the antiviral treatment group and 40 （45.5%） in the control group （P = 0.008）. Two patients in the antiviral treatment group developed severe hepatitis [2 （5.4%） vs 19 （21.6%）, P = 0.035]. In the antiviral treatment group, there was significantly less patients developing HBV reactivation [1 （2.7%） vs 16 （18.2%）, P = 0.022] or discontinuing chemotherapy （8.1% vs 33.0%, P = 0.003）. CONCLUSION： Prophylactic antiviral treatment significantly reduces the incidence of HBV reactivation in cancer patients undergoing chemotherapy.

关 键 词：实体瘤 化疗 HBV再激活 抗病毒治疗 

分 类 号：R512.62[医药卫生—内科学]