乳腺癌患者化疗后肝功能损害与乙肝病毒感染相关性研究  

Relationship between hepatic lesions after chemotherapy and hepatitis B virus infection in breast cancer patients

作　　者：邓文静[1] 余更生[1] 吕华珠[1] 

机构地区：[1]中山大学附属江门中心医院肿瘤科,广东江门529000

出　　处：《临床医学》2013年第12期16-18,共3页Clinical Medicine

摘　　要：目的探讨乙型肝炎病毒（HBV）与乳腺癌化疗后肝损害的关系及预防性拉米夫定治疗对降低继发性肝损害与HBV再激活的意义。方法收集2010年1月至2011年12月在中山大学附属江门中心医院确诊为乳腺癌并有HB—sAg检测结果的女性患者110例，所有患者均接受化疗，将其分为实验组50例（HBsAg阳性，其中19例接受了预防性拉米夫定治疗）与对照组60例（HBsAg及HBV—DNA均为阴性），化疗后肝脏毒性反应评价参照WHO标准。组间率的比较采用卡方检验。结果实验组中发生各级肝损害（42．0％vs11．7％，P〈0．01）及Ⅲ-Ⅳ度肝损害的比率（22．0％vs1．7％，P=0．001）均明显高于对照组；在50例合并HBV的患者中，预防性使用拉米夫定组的各级肝损害比例明显低于未行抗病毒组（21．1％VS54．8％，P=0．037）；其Ⅲ～Ⅳ度肝损害发生率（5．3％VS32．3％，P=0．059）及HBV再激活比例（5．3％vs29．0％，P=0．067）均明显降低。结论合并HBV感染的乳腺癌患者，化疗后肝损害与HBV感染密切相关，化疗期间预防性使用拉米夫定是一种降低继发性肝损害与HBV再激活的有效途径。Objective To investigate the relationship between hepatitis B virus （HBV） infection and hepatic lesions after chemotherapy for breast cancers and the significance of prophylactically taking orally lamivudine to decrease the chance of second- ary hepatic lesions and HBV reactivation after chemotherapy. Methods We retrospectively collected 110 breast cancers with HBsAg detection results, who were treated with chemotherapy, and then divided them into experimental group（50 cases, HBsAg positive, 19 cases out of them receiving prophylactically taking orally lamivudine） and control group （60 cases, HBsAg and HBV- DNA negative）. The evaluation of postchemotherapyhepatic lesions was in accordance with the World Health Organization （WHO） value. The X2 test was used to compare the ratios＇ differences between the two groups. Results All levels of secondary hepatic lesions and ]]I - 1Vgrade hepatic iesions of experimental group were significantly higher than that of control group, the ra- tios were 42% vs 11.7% （ P 〈 O. 01 ） and 22.0% vs 1.7% （ P = 0. 001 ） respectively. For the 50 cases with HBV infection, all levels of secondary hepatic lesions from prophylactically taking orally lamivudine group were significantly lower than the group without lamivudine （21.1% vs 54. 8%, P =0. 037）. The ratios of HI - IVgrade hepatic lesions（5.3% vs 32. 3%, P =0. 059） and HBV reactivation （5.3% vs 29. 0% , P = O. 067 ） after chemotherapy were also lower than the group without lamivudine, though there was no significant difference between them. Conclusion Postchemotherapy hepatic lesions for breast cancers with HBV infection is tightly related to HBV itself, prophylactically taking orally lamivudine is an active way to reduce the possibility of secondary hepatic lesions and HBV reactivation after chemotherapy.

关 键 词：乳腺癌 乙肝病毒 化疗 继发性肝损害 

分 类 号：R737.9[医药卫生—肿瘤]