淋巴瘤患者化学治疗前乙型肝炎病毒感染的筛查情况分析  

Screening of Hepatitis B Virus Infection before Chemotherapy for Patients with Lymphoma

作　　者：毛银燕 邓窈窕[1] 蒋明[1] 

机构地区：[1]四川大学华西医院肿瘤科,成都610041

出　　处：《华西医学》2015年第3期455-459,共5页West China Medical Journal

摘　　要：目的探讨淋巴瘤患者化学治疗(化疗)前乙型肝炎病毒(HBV)感染的筛查率和化疗后HBV的激活情况及其影响因素。方法对2010年6月-2012年7月于四川大学华西医院行化疗的449例淋巴瘤初治患者的HBV感染筛查情况进行回顾性分析。结果淋巴瘤患者化疗前HBV筛查率为86.2%,转氨酶水平升高比转氨酶正常的患者化疗前的HBV筛查率更高(OR=2.509,P=0.040)。乙型肝炎病毒表面抗原(HBs Ag)阳性的患者中,化疗后HBV激活率为16.1%(9/56),使用利妥昔单抗的患者HBV激活率更高(29.2%、6.3%,P=0.030),抗病毒治疗能明显降低HBV激活率(12.0%、50.0%,P=0.046)。HBs Ag阴性/乙型肝炎核心抗体阳性的患者中发生2例HBV激活。结论 HBV激活在合并HBV感染的淋巴瘤患者中常见,尤其是对于使用利妥昔单抗治疗的患者。淋巴瘤患者化疗前应常规筛查HBV,预防性抗病毒治疗是降低HBV激活率的有效措施。Objective To analyze the influencing factors for hepatitis B virus（HBV） infection screening in lymphoma patients prior to chemotherapy with a focus on HBV reactivation at er chemotherapy. Methods The HBV infection screening data of 449 patients with lymphoma treated by chemotherapy between June 2010 and July 2012 were analyzed retrospectively. Results Among the 449 patients, 387（86.2%） were screened for HBV before initiation of chemotherapy, and patients with elevated aminotransferase levels were more likely to receive pre-chemotherapy HBV testing（OR=2.509, P=0.040）. HBV reactivation was observed in 16.1%（9/56） of the HBs Ag-positive patients after chemotherapy, and it was more likely to occur in patients with the use of rituximab（29.2% vs. 6.3%; P=0.030）. Prophylactic antiviral therapy can significantly reduce the incidence of chemotherapy-induced HBV reactivation（12.0% vs. 50.0%; P=0.046）. Two cases of reactivation occurred in patients who were HBs Ag negative and hepatitis B core antibody positive. Conclusions HBV reactivation, especially for people with the use of rituximab, is a common complication in patients with HBV infection. HBV infection testing should be considered for lymphoma patients who were planned for chemotherapy. Prophylactic antiviral therapy can greatly decrease the incidence of HBV reactivation.

关 键 词：淋巴瘤 乙型肝炎病毒 化学疗法 激活 

分 类 号：R733.1[医药卫生—肿瘤] R512.62[医药卫生—临床医学]