HBsAg阳性恶性肿瘤患者化疗后肝损伤及HBV再激活的临床分析  

Clinical analysis of liver injury and hepatitis B virus reactivation after chemotherapy in HBsAg-positive patients with malignant tumors

作　　者：吴盛喜[1] 许鸿鹞[1] 黄河澄[1] 林连兴[1] 罗何三[1] 

机构地区：[1]汕头市中心医院肿瘤放疗科,广东汕头515031

出　　处：《临床肝胆病杂志》2016年第1期110-113,共4页Journal of Clinical Hepatology

摘　　要：目的探讨HBsAg阳性肿瘤患者化疗后肝损伤情况及HBV再激活的相关危险因素。方法收集2011年1月-2013年12月在汕头市中心医院接受化疗的HBsAg阳性的恶性肿瘤患者共150例。其中43例行预防性抗病毒治疗,即化疗前、化疗期间和化疗结束后半年使用抗病毒治疗(试验组),107例未行预防性抗病毒治疗(对照组)。回顾性分析2组患者化疗后肝损伤情况。计数资料组间比较采用χ2检验,使用Logistic回归分析法分析影响化疗后HBV再激活的相关因素。结果所有患者经过化疗,63例(42.0%)出现肝损伤,其中肝脏不良反应分级:Ⅰ度13例(8.7%)、Ⅱ度29例(19.3%)、Ⅲ度15例(10.0%)、Ⅳ度6例(4.0%),2组肝损伤程度差异具有统计学意义(χ2=19.498,P=0.001)。试验组肝损伤发生率为18.6%(8例),比对照组51.4%(55例)明显降低,差异有统计学意义(χ2=25.864,P<0.001)。Logistic单因素回归分析显示,化疗前乙型肝炎六项状态、HBV定量、是否使用激素及是否预防性使用抗病毒治疗差异具有统计学意义,将其纳入Logistic多因素回归分析显示,这4项指标均是患者化疗后HBV再激活的独立影响因素,其中预防性抗病毒治疗是患者化疗后HBV再激活唯一保护性因素。结论 HBsAg阳性肿瘤患者化疗后肝损伤发生率较高,预防性使用抗病毒治疗可以有效降低HBV再激活的发生率,从而减少肝损伤的发生。Objective To investigate the occurrence of liver injury and related risk factors for hepatitis B virus （HBV） reactivation after chemotherapy in HBsAg - positive patients with malignant tumors. Methods A total of 150 HBsAg - positive patients with malignant tumors who received chemotherapy in Shantou Central Hospital from January 2011 to December 2013 were collected ; 43 patients received prophylac- tic antiviral therapy, i. e. , the application of antiviral therapy before, during, and within half a year after chemotherapy （experiment group） , and 107 patients did not receive prophylactic antiviral therapy （control group）. The occurrence of liver injury after chemotherapy in both groups was analyzed retrospectively. Chi - square test was applied for comparison of categorical data between the two groups, and logistic regression analysis was used to investigate the related factors for HBV reactivation after chemotherapy. Results Of all, 64 patients （42. 0% ） experienced liver injury after chemotherapy, including 13 grade Ⅰ cases （8.7%） , 29 grade Ⅱ cases （ 19.3% ） , 15 grade m cases （10.0%） , and 6 grade IV cases （4.0%）, and the liver injury grade differed significantly between the two groups （X2 = 19. 498, P =0. 001 ）. The experiment group had a significantly lower incidence of liver injury than the control group （ 18.6% [8 cases] vs 52.3% [56 cases] ; X2 = 25. 864, P 〈0. 001 ）. The univariate logistic regression analysis showed that there were significant differences in six parameters of hepatitis B before chemotherapy, HBV quantification, application of hormones, and application of prophylactic antiviral therapy between the two groups. The multivariate logistic regression analysis of these four factors showed that they were all independent influencing factors for HB~ reactivation after chemotherapy, and prophylactic antiviral therapy was the only protective factor. Conclusion HBsAg - positive patients with malignant tumors have a high incidence of liver injury after c

关 键 词：肿瘤 抗肿瘤联合化疗方案 肝炎表面抗原 乙型 肝炎病毒 乙型 病毒激活 

分 类 号：R512.62[医药卫生—内科学]