HBsAg阳性非霍奇金淋巴瘤患者抗HBV治疗期间HBV再激活的危险因素分析  

Risk factors of HBV reactivation during anti-HBV therapy in non-Hodgkins lymphoma patients with HBsAg-positive

作　　者：沈满 付华丽 高世成[1] SHEN Man;FU Hua-li;GAO Shi-cheng(Department of Infectious Diseases,Zhongnan Hospital of Wuhan University,Wuhan Hubei,430071,China)

机构地区：[1]武汉大学中南医院感染科,湖北武汉430071

出　　处：《中西医结合肝病杂志》2020年第2期114-119,共6页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨HBsAg阳性非霍奇金淋巴瘤患者抗病毒治疗期间HBV再激活的危险因素,从而早期识别高危人群,指导临床治疗。方法:采用临床回顾性研究的方法,选择2011年10月至2018年3月期间在武汉大学中南医院住院治疗的90例HBsAg阳性非霍奇金淋巴瘤患者为研究对象,根据是否接受抗病毒治疗分为治疗组58例(抗病毒治疗)及对照组32例(无抗病毒治疗),观察两组患者的一般情况及实验室检查结果,比较两组患者化疗后HBV再激活、化疗延迟及肝功能损害的情况,分析HBsAg阳性非霍奇金淋巴瘤患者抗病毒治疗期间HBV再激活的危险因素。结果:两组患者平均年龄分别为(55.2±10.7)岁和(47.4±12.8)岁,差异有统计学意义(P<0.05)。治疗组患者发生HBV再激活10例(17.2%),较对照组HBV再激活12例(37.5%)显著减少,差异有统计学意义(P<0.05);两组患者化疗延迟率分别为24.1%、46.9%,差异有统计学意义(P<0.05);肝功能损害发生率分别为56.9%、40.6%,差异无统计学意义(P>0.05)。危险因素单因素分析结果显示年龄、化疗前血清HBeAg阳性、抗病毒药物种类、停用抗病毒药物及化疗周期方面,差异具有统计学意义(P<0.05)。多因素分析结果显示化疗前HBeAg阳性[OR=1.6,95%可信区间(CI):1.5~3.5],停用抗病毒药物[OR=15.5,95%可信区间(CI):1.5~171.9],化疗周期≥5[OR=3.0,95%可信区间(CI):1.2~7.7]。结论:预防性应用核苷(酸)类似物抗病毒药物能显著降低HBsAg阳性非霍奇金淋巴瘤患者化疗后HBV再激活率及化疗延迟率。化疗前血清HBeAg阳性、停用抗病毒药物及化疗周期≥5是HBsAg阳性非霍奇金淋巴瘤患者抗病毒治疗期间发生HBV再激活的独立危险因素。Objective:To explore the risk factors of HBV reactivation in non-Hodgkins lymphoma patients with HBsAg-positive during anti-HBV therapy, so as to identify high-risk groups early and guide clinical practice. Methods:A retrospective study was conducted to select 90 patients with HBsAg-positive non-Hodgkins lymphoma who were hospitalized in Zhongnan Hospital of Wuhan University from October 2011 to March 2018. According to whether or not to receive anti-hepatitis B virus treatment, 58 patients(antiviral therapy) and 32 patients in the control group(no antiviral therapy) were observed. The general conditions and laboratory tests of the two groups were observed. The HBV after chemotherapy was compared between the two groups. Activation, chemotherapy delay, and liver function impairment were used to analyze risk factors for HBV reactivation during antiviral therapy in patients with HBsAg-positive non-Hodgkins lymphoma. Results:Between the treatment group the mean ages were(55.2±10.7) years old and(47.4±12.8) years old, and the difference was statistically significant(P<0.05). There were 10 cases of HBV reactivation in the treatment group(17.2%), which was significantly lower than the control group12(37.5%). The difference was statistically significant(P<0.05). The chemotherapy delay rate of the two groups was 24.1%. 46.9%, the difference was statistically significant(P<0.05);the incidence of liver damage was 56.9%, 40.6%, the difference was not statistically significant(P>0.05). The results of single factor analysis of risk factors showed age, pre-chemotherapy serum HBeAg positive status, antiviral drug type, antiviral drug withdrawal and chemotherapy cycle, the difference was statistically significant(P<0.05). Multivariate analysis showed positive HBeAg before chemotherapy[OR=1.6, 95% confidence interval(CI):1.5~3.5];discontinuation of antiviral drugs[OR=15.5, 95% confidence interval(CI): 1.5~171.9];chemotherapy cycle ≥5[OR=3.0, 95% confidence interval(CI): 1.2~7.7]. Conclusion:Prophylactic use of nucleoside(acid)

关 键 词：HBSAG阳性 非霍奇金淋巴瘤 抗HBV治疗 HBV再激活 

分 类 号：R512.6[医药卫生—内科学]