血液病患者自体造血干细胞移植后乙型肝炎病毒再激活的临床研究  

Clinical Study of Hepatitis B Virus Reactivation in Hematological Patients with Autologous Hematopoietic Stem Cell Transplantation

作　　者：张露巍 陆棽琦 王鹏[1] 徐杨[1] 吴德沛[1] ZHANG Lu-wei;LU Shen-qi;WANG Peng;XU Yang;WU De-pei(First Affiliated Hospital of Soochow University,National Clinical Research Center for Hematologic Diseases,Jiangsu Institute of Hematology,Institute of Hematopoietic Stem Cell Transplantation,Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院,国家血液系统疾病临床医学研究中心,江苏省血液研究所,苏州大学造血干细胞移植研究所,江苏苏州215006

出　　处：《中国血液流变学杂志》2022年第2期197-201,269,共6页Chinese Journal of Hemorheology

基　　金：国家重点研发计划(2017YFA0104500,2019YFC0840604);江苏省医学杰出人才(JCRCA2016002);江苏省重点研发计划(BE2019798)。

摘　　要：目的探讨影响移植前乙肝表面抗原(HBsAg)阳性的恶性血液病患者行自体造血干细胞移植后乙肝病毒再激活的因素,比较乙肝病毒再激活及未激活患者的预后。方法回顾性分析2015年1月—2020年12月接受自体造血干细胞移植且HBsAg阳性的40例恶性血液病患者临床资料,使用竞争风险模型进行乙肝病毒再激活的危险因素分析,使用Kaplan-Meier法进行生存分析,比较乙肝病毒再激活与未再激活患者的总体生存率(OS)及无进展生存率(PFS)。结果40例患者中移植后发生乙肝病毒再激活的有4例,乙肝病毒再激活的发生率为10%。血液病本病复发是导致乙肝病毒再激活的独立预后因素(HR:16.294,95%CI:1.687~157.386;P=0.016)。无乙肝病毒再激活的患者OS(73%vs.0%;P=0.021)及PFS(74%vs.38%;P=0.027)均优于乙肝病毒再激活患者,差异具有统计学意义。结论乙肝病毒再激活常导致自体造血干细胞移植患者较差的预后,病程中需定期检测HBV-DNA并严格进行预防性抗病毒治疗。Objective To investigate the factors associated with hepatitis B virus reactivation(HBV reaction)after autologous hematopoietic stem cell transplantation(auto-HSCT)in patients with hematological malignancies and positive for hepatitis B surface antigen(HBsAg)before transplantation,and to compare the prognosis of patients with and without HBV reactivation.Methods The clinical data of 40 patients with hematological malignancies who received auto-HSCT and were positive for HBsAg from January 2015 to December 2020 were retrospectively analyzed.The risk factors for HBV reactivation were analyzed using a competing risk model,and Kaplan-Meier method was used for survival analysis to compare the overall survival(OS)and progressionfree survival(PFS)of HBV reactivation and non-reactivation patients.Results Four of the 40 patients had HBV reactivation after transplantation,and the incidence was 10%.Relapse of hematologic disease was an independent prognostic factor for HBV reactivation(HR:16.294,95%CI:1.687-157.386,P=0.016).Patients without HBV reactivation had better OS(73%vs.0%,P=0.021)and PFS(74%vs.38%,P=0.027)than the HBV reactivation group,and the difference was statistically significant.Conclusion HBV reactivation often leads to poor prognosis after auto-HSCT.Periodic detection of HBV-DNA and strict preventive antiviral treatment are required during the course of the disease.

关 键 词：乙肝病毒再激活 自体造血干细胞移植 HBV-DNA监测 抗病毒治疗 

分 类 号：R733[医药卫生—肿瘤]