弥漫大B细胞淋巴瘤患者化疗后HBV再激活的影响因素  

Influencing factors for reactivation of HBV in patients with diffuse large B-cell lymphoma

作　　者：陈宛丽[1] 姚金晓 杨莹[1] 王舒[1] 刘冰[1] CHEN Wan-li;YAO Jin-xiao;YANG Ying;WANG Shu;LIU Bing(Nanyang Second General Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市第二人民医院血液淋巴瘤科,河南南阳473000

出　　处：《中华医院感染学杂志》2022年第18期2803-2807,共5页Chinese Journal of Nosocomiology

基　　金：河南省卫生科技计划项目(2018108)。

摘　　要：目的 探讨弥漫大B细胞淋巴瘤(DLBCL)合并乙肝病毒(HBV)携带或既往HBV感染患者化疗后HBV再激活影响因素。方法 选取2019年6月-2020年12月南阳市第二人民医院收治的96例HBV携带或既往HBV感染的DLBCL患者为研究对象,根据患者化疗前的乙肝病毒检查结果分为HBsAg阳性组40例和HBsAg阴性组56例。比较两组患者的临床资料,分析R-CHOP化疗6个疗程后疗效、肝功能、HBV再激活率,多因素logistic回归分析HBV再激活的影响因素。结果 HBsAg阳性组的化疗总缓解率(60.00%)低于HBsAg阴性组(82.14%)(P<0.05);HBsAg阳性组患者肝功能损害的发生率(42.50%)高于HBsAg阴性组(21.43%)(P<0.05);HBsAg阳性组患者HBV再激活发生率(22.50%)高于HBsAg阴性组的(3.57%)(P<0.05);抗-HBe(+)、抗-HBs(-)是患者化疗后HBV再激活的影响因素(P<0.05)。结论 抗-HBe(+)、抗-HBs(-)增加化疗后HBV再激活的风险,降低化疗缓解率,导致肝功能损害,建议此类患者在化疗前实施抗病毒治疗,并严密检测肝功能及HBV-DNA复制情况。OBJECTIVE To explore the influencing factors for reactivation of hepatitis B virus(HBV) in diffuse large B-cell lymphoma(DLBCL) patients complicated with HBV carrier or previous HBV infection.METHODS Totally 96 DLBCL patients who were complicated with HBV carrier or previous HBV infection and treated in Nanyang Second General Hospital from Jun 2019 to Dec 2020 were recruited as the study subjects and were divided into the HBsAg-positive group with 40 cases and the HBsAg-negative group with 56 cases according to the result of HBV test before chemotherapy.The clinical data were compared between the two groups of patients.The curative effect,liver function and reactivation rate of HBV were observed after 6 courses of R-CHOP chemotherapy.Multivariate logistic regression analysis was performed for the influencing factors for reactivation of HBV.RESULTS The total remission rate of chemotherapy of the HBsAg-positive group was 60.00%,significantly lower than 82.14% of the HBsAg-negative group(P<0.05).The incidence of liver function damage of the HBsAg-positive group was 42.50%,significantly higher than 21.43% of the HBsAg-negative group(P<0.05).The incidence of reactivation of HBV was 22.50% in the HBsAg-positive group,significantly higher than 3.57% in the HBsAg-negative group(P<0.05).Anti-HBe(+) and anti-HBs(-) were the influencing factors for the reactivation of HBV after chemotherapy(P<0.05).CONCLUSION Anti-HBe(+) and anti-HBs(-) may increase the risk of reactivation of HBV after chemotherapy,reduce the remission rate of chemotherapy and result in liver function damage.It is suggested that antiviral therapy should be carried out before chemotherapy,and the liver function and status of HBV-DNA replication should be closely monitored.

关 键 词：弥漫大B细胞淋巴瘤 化疗 乙肝病毒 携带者 既往HBV感染 再激活 肝功能 

分 类 号：R551.2[医药卫生—血液循环系统疾病]