恶性血液病化学治疗后乙型肝炎病毒的激活  

Retrospective study of hepatitis B virus reactivation after chemotherapy in patients with hematologicalmalignant diseases

作　　者：卜亚静[1] 孟力[1] 何丽[1] 汤静[1] 汤屹[1] 周剑峰[1] 张义成[1] 孙汉英[1] 刘文励[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院血液科,武汉430030

出　　处：《中华传染病杂志》2013年第8期471-474,共4页Chinese Journal of Infectious Diseases

摘　　要：目的了解HBsAg阴性、抗-HBc阳性恶性血液病患者经化学治疗后HBV激活的情况。方法对2009年1月1日至2012年3月1日武汉市同济医院血液科住院的恶性血液病患者215例进行回顾性研究。其中HBsAg阴性、抗一HBc阳性患者102例，除化学治疗后失访或未接受化学治疗的病例，仅36例患者检测化学治疗前后肝功能、HBV血清学标志物等，化学治疗前均未行预防性抗病毒治疗。结果在完成随访的36例患者中，化学治疗后有2例HBsAg转阳，其中1例为抗-HBs阳性的套细胞淋巴瘤患者行利妥昔单抗＋环磷酰胺＋阿霉素＋长春地辛＋泼尼松方案化学治疗，另1例抗－HBs阴性的慢性淋巴细胞白血病患者经氟达拉滨＋环磷酰胺方案化学治疗后HBV激活。结论HBsAg阴性、抗－HBc阳性的恶性血液病患者化学治疗后可出现HBV激活。Objective To investigate the reactivation of hepatitis B virus （HBV） after chemotherapy in hepatitis B surface antigen （HBsAg） negative and hepatitis B core antibody （HBcAb） positive patients with hematological malignant diseases. Methods A retrospective research was performed in 215 patients with hematological malignant diseases who were hospitalized in Department of Hematology, Tongji Hospital, Wuhan, China between January 1, 2009 and March 1, 2012. Totally 102 out of these patients were HBsAg negative and HBcAb positive. Because of the patient lost during follow up or not receiving chemotherapy, only 36 patients had liver function results and serum markers of HBV both before and after chemotherapy. None of the patients received prophylactic antiviral treatment before chemotherapy. Results Two of the 36 patients had hepatitis associated with HBV reactivation and turned to HBsAg positive during treatment, including one with mantle cell lymphoma treated with rituximab＋cyclophosphamide＋doxorubicin＋vindesine＋prednisone （ R- CHOP） chemotherapy regimen who was hepatitis B surface antibody （HBsAb） positive before chemotherapy, and the other with chronic lymphocytic leukemia received fludarablne ＋ cyclophosphamide （FC） chemotherapy regimen who was HBsAb negative before chemotherapy. Conclusion Our study indicates that chemotherapy may cause HBV reactivation in HBsAg negative and HBcAb positive patients with hematological malignant diseases.

关 键 词：肝炎病毒 乙型 肝炎表面抗原 乙型 肝炎抗体 乙型 病毒激活 血液肿瘤 药物疗法 

分 类 号：R55[医药卫生—血液循环系统疾病]