Clinical comparison of preventive and therapeutic effects of lamivudine and entecavir on HBV reactivation among patients with non- Hodgkin lymphoma
-
摘要:
目的对比观察拉米夫定及恩替卡韦在预防和治疗非霍奇金淋巴瘤(NHL)合并慢性HBV感染的患者化疗期间出现HBV再激活的有效性。方法自2008年1月至2013年4月,共收集NHL合并HBV感染患者94例,分为拉米夫定治疗组和恩替卡韦治疗组,两组化疗同时分别服用拉米夫定(100 mg/d)和恩替卡韦(0.5 mg/d),就组间病毒学突破率,原发性无应答率、病毒学突破相关性肝炎突发等方面进行对比。计量资料2组独立样本用t检验,3组独立样本用单因素方差分析进行比较;计数资料用χ2检验进行组间比较。结果抗HBV治疗前HBV DNA<103拷贝 2="1.03,P">0.05)。抗HBV治疗前HBV DNA>103拷贝/ml组,服用拉米夫定的患者病毒学突破率为37.5%,原发耐药率为9.4%,肝炎突发率28.1%,肝衰竭发生率3.1%;服用恩替卡韦的患者上述指标分别为3.1%、0、0、0,两者病毒学突破率及肝炎突发率均有统计学差异(χ2=11.68、10.47,P<0.05)。结论 NHL合并HBV感染患...
Abstract:Objective To investigate the preventive and therapeutic effects of lamivudine and entecavir on hepatitis B virus (HBV) reactivation among non- Hodgkin lymphoma (NHL) patients with chronic HBV infection during chemotherapy.Methods From January 2008 to April 2013, a total of 94 NHL patients with HBV infection were recruited from our hospital and divided into lamivudine treatment group and entecavir treatment group.The lamivudine treatment group received chemotherapy with lamivudine (100 mg / d) , and the entecavir treatment group received chemotherapy with entecavir (0.5 mg / d) .The rates of virological breakthrough, primary non- response, and virological breakthrough- related hepatitis flare were compared between groups.The t- test was used for comparison between two groups of independent samples;one- way analysis of variance was conducted for comparison between three groups of independent samples;the chi- square test was used to conduct intergroup comparison.Results For the patients with HBV DNA levels lower than 103copies / ml before anti- HBV treatment, no significant difference was found in the rate of virological breakthrough or rate of hepatitis flare between lamivudine treatment group and entecavir treatment group (χ2= 1.03, P > 0.05) .For the patients with HBV DNA levels higher than 103copies / ml before anti-HBV treatment, the lamivudine treatment group had a virological breakthrough rate of 37.5%, a primary non- response rate of 9.4%, a hepatitis flare rate of 28.1%, and a liver failure rate of 3.1%, and the aforementioned rates for entecavir treatment group were 3.1%, 0, 0, and 0, respectively;there were significant differences in the rates of virological breakthrough and hepatitis flare between the two groups (χ2= 11.68, P < 0.05;χ2= 10.47, P < 0.05) .Conclusion Among NHL patients with HBV infection whose HBV DNA levels are lower than 103copies / ml, the preventive and therapeutic effects of lamivudine and entecavir on HBV reactivation are similar;among NHL patients with HBV infection whose HBV DNA levels are higher than 103copies / ml, those treated with entecavir have lower rates of virological breakthrough and hepatitis flare than those treated with lamivudine, which helps patients have a smoother progress of chemotherapy.
-
Key words:
- lymphoma, non-Hodgkin /
- hepatitis B virus /
- lamivudine /
- entecavir
-
[1]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 version) [J].J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ. [2]Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Assosiation.The guideline for preventiong and treatment of chronic hepatitis B[J].J Clin Hepatol, 2006, 22 (1) :3-15. (in Chinese) 中华医学会肝病分会, 中华医学会感染病分会.慢性乙型肝炎防治指南[J].临床肝胆病杂志, 2006, 22 (1) :3-15. [3]ZHENG RS, QIN FZ, ZHAI YZ, et al.HBV infection and chemotherapy of Non-Hodgkin's lymphoma[J].Pract J Cancer, 2001, 16 (2) :181-182. (in Chinese) 郑荣生, 秦凤展, 翟云芝, 等.感染乙肝病毒的非霍奇金淋巴瘤化疗方案的研究[J].实用癌症杂志, 2001, 16 (2) :181-182. [4]YEO W, CHAN PK, ZHONG S.Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy:a prospective study of 626 patients with identification of risk factors[J].J Med Virol, 2000, 62 (3) :209-307. [5]YEO W, HUI EP, CHAN AT.Prevention of hepatitis B virus reactivation in patients with nasopharyngeal carcinoma with Lamivudine[J].Am J Clin Oncol, 2005, 28 (4) :379-384. [6]LIN Y, Chen WM.Activation of hepatitis B virus in HBsAg-negative and HBcAg-positive patients with non-Hodgkin's lymphoma after R-CHOP regimen:a report of 2 cases[J].Chin J Pract Intern Med, 2013, 33 (2) :166-168. (in Chinese) 林芸, 陈为民.非霍奇金淋巴瘤并乙肝表面抗原阴性核心抗体阳性患者接受类R-CHOP方案化疗后乙肝病毒激活2例报告[J].中国实用内科杂志, 2013, 33 (2) :166-168. [7]GUAN ZZ, WANG XS.Study on the current situation of B cell lymphoma to chemotherapy[J].Chin J Oncol, 2005, 27 (12) :760-761. (in Chinese) 管忠震, 王树森.B细胞淋巴瘤化疗研究现状[J].中华肿瘤杂志, 2005, 27 (12) :760-761. [8]DAI MS, CHAO TY, KAO WY.Delayed hepatitis B virus reactivation after cessation of preemptive Lamivudine in lymphoma patients treated with rituximab plus CHOP[J].Ann Hematol, 2004, 83 (12) :769-774. [9]LOOMBA R, ROWLEY A, WESLEY R, et al.Systematic review:the effect of preventive Lamivudine on hepatitis B reactivation during chemotherapy[J].Ann Intern Med, 2008, 148 (7) :519-528. [10]FAN XH, HU YL, ZHU HL.Study on YMDD mutation during lamivudine therapy of chronic hepatitis B[J].J Clin Hepatol, 2009, 25 (3) :192-194. (in Chinese) 樊晓红, 胡玉琳, 朱红玲.拉米夫定治疗慢性乙型肝炎发生YMDD变异的研究[J].临床肝胆病杂志, 2009, 25 (3) :192-194. [11] Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline for prevention and treatment of chronic hepatitis B[J].J Clin Hepatol, 2006, 22 (1) :3-15. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南[J].临床肝胆病杂志, 2006, 22 (1) :3-15. [12]LUO WM, ZHANG YC, LIU ZJ.Clinical observation about entecavir in treating chronic hepatitis B at the initial stage[J].J Clin Hepatol, 2008, 24 (1) :26-28. (in Chinese) 罗玮敏, 张迎春, 刘中景.恩替卡韦治疗慢性乙型肝炎的早期临床观察[J].临床肝胆病杂志, 2008, 24 (1) :26-28. [13]KONG HW, WANG YD, ZHU TY.Effect comparison of entecavir and lamivudine in treatment of chronic hepatitis B[J].J Clin Exp Med, 2012, 11 (19) :1537-1539. (in Chinese) 孔弘伟, 王亚东, 竺添雨.恩替卡韦、拉米夫定治疗慢性乙型肝炎临床疗效比较[J].临床和实验医学杂志, 2012, 11 (19) :1537-1539. [14]JI D, CHEN GF, LI YG, et al.Clinical observation on 50 cases of chronic hepatitis B virus infection patients treated with entecavir[J/CD].Chin J Exp Clin Infact Dis:Electronic Edition, 2008, 2 (2) :46-47. (in Chinese) 纪冬, 陈国凤, 李永纲, 等.恩替卡韦治疗慢性乙型肝炎病毒感染患者50例的短期疗效观察[J/CD].中华实验和临床感染病杂志:电子版, 2008, 2 (2) :46-47. [15]SHENG QJ, DING Y, DOU XG.Stratified evaluation on effects of entecavir on chronic hepatitis B[J].Pract Pharm Clin Remed, 2010, 13 (3) :167-171. (in Chinese) 盛秋菊, 丁洋, 窦晓光.恩替卡韦治疗慢性乙型肝炎疗效的早期分层评价[J].实用药物与临床, 2010, 13 (3) :167-171. [16]TANG MH, CHEN J, RAO LP.Comparison of the efficacy of entecavir, adefovir, lamivudine treatment for chronic hepatitis B[J].J Guangdong Med Coll, 2012, 30 (2) :156-158. (in Chinese) 唐茂华, 陈积, 饶丽萍.恩替卡韦、阿德福韦、拉米夫定治疗慢性乙型肝炎的疗效比较[J].广东医学院学报, 2012, 30 (2) :156-158. -
![WeChat](/fileLCGDBZZ/journal/article/lcgdbzz/2014/4/WECHAT/wechat_cn_LCGD201404024.jpg)
计量
- 文章访问数: 2030
- HTML全文浏览量: 22
- PDF下载量: 433
- 被引次数: 0