HBsAg阴性/抗-HBc阳性患者抗肿瘤相关HBV再激活风险的前瞻性评估  

Risk of hepatitis B virus reactivation in HBsAg negative/anti-HBc positive patients with malignancies:a prospective study

作　　者：郝坤艳 张怡青 王锋 朱浩 汪文洋 沈敏 陈晓慧 李平 于乐成 HAO Kun-yan;ZHANG Yi-qing;WANG Feng;ZHU Hao;WANG Wen-yang;SHEN Min;CHEN Xiao-hui;LI Ping;YU Yue-cheng(Center of Hepatology and Department of Infectious Disease,Jinling Hospital(General Hospital of Eastern Theater Command)Affiliated to School of Medicine,Nanjing University,Jiangsu 210002,China;Department of Clinical Laboratory,Jinling Hospital(General Hospital of Eastern Theater Command)Affiliated to School of Medicine,Nanjing University,Jiangsu 210002,China;Department of Oncology,Jinling Hospital(General Hospital of Eastern Theater Command)Affiliated to School of Medicine,Nanjing University,Jiangsu 210002,China;Department of Pharmacy,Jinling Hospital(General Hospital of Eastern Theater Command)Affiliated to School of Medicine,Nanjing University,Jiangsu 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)感染病科与肝病中心,江苏210002 [2]南京大学医学院附属金陵医院(东部战区总医院)检验科,江苏210002 [3]南京大学医学院附属金陵医院(东部战区总医院)肿瘤科,江苏210002 [4]南京大学医学院附属金陵医院(东部战区总医院)药学科,江苏210002

出　　处：《肝脏》2024年第12期1464-1467,1471,共5页Chinese Hepatology

基　　金：南京大学医学院附属金陵医院(东部战区总医院)临床科研课题(22LCZLXJS14)。

摘　　要：目的 评估HBsAg阴性/抗-HBc阳性患者抗肿瘤治疗相关HBV再激活(HBV reactivation, HBVr)的发生率。方法 以2021年6至7月在东部战区总医院肿瘤科住院的HBsAg-/抗-HBc+、并接受抗肿瘤治疗的恶性肿瘤患者为研究对象。收集人口学资料、肿瘤类型、抗肿瘤治疗方案、基线及抗癌治疗6个月时的HBV RNA、HBV DNA、HBsAg及HBeAg相关指标,其中任何一项指标转阳即判断为HBVr,统计并分析HBVr发生率。结果 纳入HBsAg-/抗-HBc+恶性肿瘤患者36例。基线血清HBV DNA<10 IU/mL,HBV RNA<50拷贝/mL;HBsAg及HBeAg均阴性;抗-HBs阳性24例(66.67%),抗-HBs≥100 mIU/mL 9例(25.00%)。抗肿瘤方案高风险2例(5.56%)、中风险4例(11.11%)、低风险26例(72.22%)、不确定风险4例(11.11%)。治疗6个月时,HBVr的发生率为8.33%(3/36)。高、中、低和不确定风险组的HBVr分别为0%(0/2)、25%(1/4)、3.85%(1/26)和25%(1/4)。抗-HBs阳性组与阴性组(3/24比0/12,P=0.54)、抗-HBs≥100 mIU/mL组与<100 mIU/mL组(1/9比2/27,P=1.00)之间的HBVr率差异均无统计学意义。3例HBVr患者均表现为血清HBV DNA弱阳性(12.49、19.24及71.55 IU/mL),分别位于中、低、不确定风险组,基线抗-HBs分别为23.19、1.23和145.58 mIU/mL。结论 HBsAg-/抗-HBc+且HBV RNA和HBV DNA均低于检测下限的恶性肿瘤患者,甚至是基线抗-HBs水平相对高、采用低风险或不确定风险抗肿瘤方案的患者,仍存在HBVr风险。Objective To prospectively evaluate the rate of hepatitis B virus reactivation(HBVr)in HBsAg negative/anti-HBc positive(HBsAg-/anti-HBc+)patients with malignancies,thus to assess the risk of HBVr more accurately and optimize the management in this special population.Methods HBsAg-/anti-HBc+patients with malignant tumors admitted to the Department of Oncology in a tertiary hospital from June to July 2021 and received anti-tumor treatment were selected as the subjects.Demographic data,tumor type,anti-tumor regimen,HBV markers such as HBV RNA,HBV DNA,HBsAg and HBeAg were collected prospectively at baseline and 6 months of anti-tumor treatment.HBVr was confirmed if any of the HBV markers turned positive,and the incidence of HBVr was analyzed to evaluate the risk of HBVr in the HBsAg-/anti-HBc+background.Results A total of 36 HBsAg-/anti-HBc+patients with malignancies were included,all of whom had baseline serum HBV DNA<10 IU/mL,HBV RNA<50 copies/mL,HBsAg and HBeAg negative.Anti-HBs was detectable in 24 cases(66.67%),with 9 patients(25.00%)had anti-HBs≥100 mIU/mL.There were 2 patients(5.56%)in high risk subgroup,4 patients(11.11%)in moderate risk subgroup,26 patients(72.22%)in low risk subgroup,and 4 patients(11.11%)in uncertain risk subgroup.After 6 months of anti-cancer treatment,the total incidence of HBVr was 8.33%(3/36).The rates of HBVr in the high,moderate,low and uncertain risk subgroups were 0%(0/2),25%(1/4),3.85%(1/26)and 25%(1/4),respectively.No significant difference in HBVr rates were seen between anti-HBs positive and negative subgroups(3/24 vs 0/12,P=0.54),or between anti-HBs≥100 mIU/mL and<100 mIU/mL subgroups(1/9 vs 2/27,P=1.00).The levels of HBV DNA by the end of 6 months in the three HBVr patients(with baseline anti-HBs and risk stratification of anti-tumor treatment)were 12.49 IU/mL(23.19 mIU/mL and moderate risk),19.24 IU/mL(1.23 mIU/mL and low risk),and 71.55 IU/mL(145.58 mIU/mL and uncertain risk).Conclusion Tumor patients with baseline HBsAg-/anti-HBc+and both HBV RNA and HBV DNA below the

关 键 词：抗-HBC阳性 HBSAG阴性 HBV RNA HBV DNA 抗肿瘤治疗 HBV再激活 

分 类 号：R51[医药卫生—内科学]