恩替卡韦预防肺癌携带 HBV 患者化疗后HBV 再激活的临床研究  

A clinical study of preventive effect of entecavir on HBV reactivation in lung cancer with HBV carriers after chemotherapy

作　　者：车德海[1] 李珍[1] 徐刚[1] 于雁[1] 张华[1] 刘彦[1] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院内科, 哈尔滨 150081

出　　处：《实用肿瘤学杂志》2014年第1期7-11,共5页Practical Oncology Journal

基　　金：黑龙江省教育厅科学技术研究项目（12511346）

摘　　要：目的：探讨化疗引起的肺癌患者乙肝病毒再激活与肝功能损害的相关性及恩替卡韦对化疗后乙肝病毒再激活的预防作用。方法收集2011年1月-2012年12月，在哈尔滨医科大学附属肿瘤医院经病理证实的160例携带乙型肝炎病毒的肺癌患者的临床资料进行回顾性分析，按照治疗方法的不同分为两组：预防组80例，对照组80例。预防组在化疗前给予口服恩替卡韦（0．5 mg/d），至化疗后6个月，对照组患者给予化疗未接受恩替卡韦治疗。比较两组化疗后乙肝病毒再激活、肝功能损害、化疗延迟、化疗的毒性反应等指标变化。结果预防组乙肝病毒再激活发生率为5％，对照组为25％，两组比较差异有统计学意义（P＜0．01），乙肝病毒再激活与HBV-DNA载量有关，HBV-DNA≥104copies/mL容易发生乙肝病毒再激活，而与肺癌的病理类型、临床分期、是否含铂方案化疗及是否HBeAg阳性无关（ P＞0．05）；肝功能损害方面，预防组肝功能损害率为40％，对照组为70％，两组比较差异有统计学意义（ P＜0．01），具体分级中，预防组Ⅲ、Ⅳ度肝功能损害率为5％，对照组为30％，两组比较差异有统计学意义（P＜0．05），而Ⅰ、Ⅱ度预防组为35％，对照组为40％，两组比较差异无统计学意义（P＞0．05）；肝功能损害所致的化疗延迟率比较，预防组为5％，对照组为20％，两组比较差异有统计学意义（ P＜0．05）；两组化疗的主要毒性反应为骨髓抑制、恶心、呕吐、疲乏等，多为1～2级，经支持对症处理可以恢复。结论预防性口服恩替卡韦可以降低携带乙肝病毒的肺癌患者乙肝病毒再激活的风险。Objective The present study aims to determine the correlation between liver function dam-age and hepatitis B virus （ HBV ） reactivation caused by chemotherapy , and the preventive effect of entecavir on HBV reactivation in lung cancer with HBV carriers .Methods A total of 160 lung cancer patients with HBV car-riers in the affiliated tumor hospital of Harbin Medical University from January 2011 to December 2012 was inves-tigated and the clinical data were studied retrospectively .The patients were divided into prophylactic group （ n=80）and control group（n=80）.In prophylactic group,0.5 mg of daily oral entecavir was administered before the chemotherapy until 6 months after the completion of chemotherapy .Control group received no entecavir .The inci-dence of HBV reactivation ,functional damage of liver ,toxicities and disruption of chemotherapy were measured . Results The comparison between the control group （25%） and prevent group （5%） showed a statistically signifi-cant difference in the incidence of HBV reactivation （P＆lt;0.01）.Moreover,HBV-DNA level（HBV-DNA≥104 copies/mL）was risk factors of HBV reactivation （P＆lt;0.05）.Histology and stage of lung cancer,the chemother-aphy scheme containing platinum , positive HBeAg were not significantly correlated with HBV reactivation （ P＆gt;0.05）.There were significant differences in grade III and IV hepatic toxicity （P＆lt;0.05）between control group （30%）and prevent group（5%）,but was not in grade I and II hepatic toxicity （P＆gt;0.05）.Disruption of chemo-therapy showed significant difference between control group （20%）and prevent group（5%）（P＆lt;0.05）.The ma-jor grade 1 ~2 toxicities were myelosuppression,nausea,vomiting,skin rash,diarrhoea,neurotoxicity,fatigue, headache,insomnia,etc.All adverse reactions were cured after treatment .Conclusion The prophylactic adminis-tration of oral entecavir could reduce the risk of HBV reactivation in lung cancer with HBV carriers .

关 键 词：肺癌 化疗 恩替卡韦 乙肝病毒再激活 肝功能损害 

分 类 号：R734.2[医药卫生—肿瘤]