核苷类药物对恶性肿瘤患者化疗后乙型肝炎病毒再激活的研究  

Effect of nucleoside analogues on reactivation of hepatitis B virus in patients with malignancies after chemotherapy

作　　者：杨小舟[1] 崔铁军[1] 解莹[1] 王红旗[1] 刘群[1] 刘文芝[1] 

机构地区：[1]大连医科大学附属第二医院感染科,辽宁大连116023

出　　处：《中华医院感染学杂志》2016年第2期289-291,297,共4页Chinese Journal of Nosocomiology

基　　金：辽宁省科技厅基金资助项目(2010225034)

摘　　要：目的研究恶性肿瘤患者化疗后乙型肝炎病毒(HBV)再激活情况,探讨应用核苷类药物预防性抗HBV再激活的疗效。方法选取2012年3月-2014年3月40例肿瘤内科及血液内科住院的恶性肿瘤合并HBV感染患者,将患者分为观察组18例和对照组22例,观察组至少化疗前1周予核苷类药物口服,至化疗疗程结束后6个月;对照组化疗前仅给予保肝降酶治疗,出现HBV-DNA升高时再予核苷类药物抗病毒治疗,至化疗疗程结束后6个月;比较两组患者化疗后HBV再激活发生率、血清病毒学指标(乙型肝炎五项定量、HBV-DNA)及肝生化学指标差异;采用SPSS17.0进行统计分析。结果观察组和对照组患者化疗后4、12周、化疗结束时、化疗结束后24周的HBV激活率随着化疗周期的延长呈逐渐升高的趋势,差异有统计学意义(P<0.05);两组患者化疗后4周血清病毒学指标、肝生化学指标方面差异无统计学意义;化疗后12周、化疗结束时两组患者血清病毒学指标,肝生化学指标差异有统计学意义(P<0.05);化疗结束后24周,两组患者血清病毒学指标、肝生化学指标方面差异均无统计学意义。结论化学药物治疗可以诱发恶性肿瘤患者HBV再激活,且随着化疗周期的逐渐延长,激活率呈上升趋势,所以化疗过程中应密切监测肝功能及HBV-DNA;化疗前予核苷类药物预防性抗病毒治疗可明显降低HBV再激活发生率。OBJECTIVE To study the reactivation of hepatitis B virus（HBV）in patients with malignancies after chemotherapy and explore the efficacy of nucleoside analogues prophylaxis in prevention of the reactivation of HBV.METHODS A total of 40 malignancies patients complicated with HBV infections who were hospitalized the oncology department and hematology department from Mar 2012 to Mar 2014 were enrolled in the study and divided into the observation group with 18 cases and the control group with 22 cases.The observation group was treated with oral administration of nucleoside analogues from at least one week before the chemotherapy to 6months after the chemotherapy,while the control group was only given hepato-protective and descending enzyme therapy and was treated with nucleoside analogues for antiviral therapy till 6months after the chemotherapy as the HBV-DNA was elevated.The incidence of reactivation of HBV,serum virological indicators（hepatitis B five quantitations,HBV-DNA）,and hepatic biochemical indicators were observed and compared between the two groups of patients after the chemotherapy;the statistical analysis was performed with the use of SPSS17.0software.RESULTS The rate of reactivation of HBV in the patients of the observation group and the control group was increased with the cycle of chemotherapy after the chemotherapy for 4 weeks,12 weeks,at the end of chemotherapy,and for 24 weeks,with statistical significance（P〈0.05）.There was no significant difference in the serum virological indicators or hepatic biochemical indicators between the two groups of patients after the chemotherapy for 4 weeks.There was significant difference in the serum virological indicators or hepatic biochemical indicators between the two groups of patients after the chemotherapy for 12 weeks or at the end of chemotherapy（P〈0.05）.There was no significant difference in the serum virological indicators or hepatic biochemical indicators between the two groups of patients after the chemotherapy for 24 weeks.CONCLUSION

关 键 词：乙型肝炎病毒 再激活 肿瘤 化疗 核苷类药物 

分 类 号：R512.62[医药卫生—内科学]