HBsAg阳性恶性肿瘤患者化疗后肝损伤及HBV再激活的临床分析

吴盛喜; 许鸿鹞; 黄河澄; 林连兴; 罗何三

doi:10.3969/j.issn.1001-5256.2016.01.020

HBsAg阳性恶性肿瘤患者化疗后肝损伤及HBV再激活的临床分析

DOI: 10.3969/j.issn.1001-5256.2016.01.020

汕头市中心医院肿瘤放疗科

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中图分类号: R512.62;R730.5
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出版历程
- 收稿日期: 2015-05-22
- 出版日期: 2016-01-20

Clinical analysis of liver injury and hepatitis B virus reactivation after chemotherapy in HBsAg-positive patients with malignant tumors

Department of Radiation Oncology,Shantou Central Hospital

摘要

摘要: 目的探讨HBsAg阳性肿瘤患者化疗后肝损伤情况及HBV再激活的相关危险因素。方法收集2011年1月-2013年12月在汕头市中心医院接受化疗的HBsAg阳性的恶性肿瘤患者共150例。其中43例行预防性抗病毒治疗,即化疗前、化疗期间和化疗结束后半年使用抗病毒治疗（试验组）,107例未行预防性抗病毒治疗（对照组）。回顾性分析2组患者化疗后肝损伤情况。计数资料组间比较采用χ2检验,使用Logistic回归分析法分析影响化疗后HBV再激活的相关因素。结果所有患者经过化疗,63例（42.0%）出现肝损伤,其中肝脏不良反应分级:Ⅰ度13例（8.7%）、Ⅱ度29例（19.3%）、Ⅲ度15例（10.0%）、Ⅳ度6例（4.0%）,2组肝损伤程度差异具有统计学意义（χ2=19.498,P=0.001）。试验组肝损伤发生率为18.6%（8例）,比对照组51.4%（55例）明显降低,差异有统计学意义（χ2=25.864,P<0.001）。Logistic单因素回归分析显示,化疗前乙型肝炎六项状态、HBV定量、是否使用激素及是否预防性使用抗病毒治疗差异具有统计学意义,将其纳入Logistic多因素回归分析...
- 肿瘤 /
- 抗肿瘤联合化疗方案 /
- 肝炎表面抗原,乙型 /
- 肝炎病毒,乙型 /
- 病毒激活
Abstract: Objective To investigate the occurrence of liver injury and related risk factors for hepatitis B virus( HBV) reactivation after chemotherapy in HBsAg- positive patients with malignant tumors. Methods A total of 150 HBsAg- positive patients with malignant tumors who received chemotherapy in Shantou Central Hospital from January 2011 to December 2013 were collected; 43 patients received prophylactic antiviral therapy,i. e.,the application of antiviral therapy before,during,and within half a year after chemotherapy( experiment group),and 107 patients did not receive prophylactic antiviral therapy( control group). The occurrence of liver injury after chemotherapy in both groups was analyzed retrospectively. Chi- square test was applied for comparison of categorical data between the two groups,and logistic regression analysis was used to investigate the related factors for HBV reactivation after chemotherapy. Results Of all,64 patients( 42. 0%) experienced liver injury after chemotherapy,including 13 grade Ⅰ cases( 8. 7%),29 grade Ⅱ cases( 19. 3%),15 grade Ⅲcases( 10. 0%),and 6 grade Ⅳ cases( 4. 0%),and the liver injury grade differed significantly between the two groups( χ2= 19. 498,P = 0. 001). The experiment group had a significantly lower incidence of liver injury than the control group( 18. 6% [8 cases] vs 52. 3%[56 cases]; χ2= 25. 864,P < 0. 001). The univariate logistic regression analysis showed that there were significant differences in six parameters of hepatitis B before chemotherapy,HBV quantification,application of hormones,and application of prophylactic antiviral therapy between the two groups. The multivariate logistic regression analysis of these four factors showed that they were all independent influencing factors for HBV reactivation after chemotherapy,and prophylactic antiviral therapy was the only protective factor. Conclusion HBsAg-positive patients with malignant tumors have a high incidence of liver injury after chemotherapy,and prophylactic antiviral therapy can effectively reduce the incidence of HBV reactivation and liver injury after chemotherapy in HBsAg- positive patients.
- neoplasms /
- antineoplastic combined chemotherapy protocols /
- hepatitis B surface antigens /
- hepatitis B virus /
- virus activation

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参考文献(18)

[1]HU XL,ZHAO HW,WU XY,et al.Prevalence of hepatitis B virus infection[J].J Clin Hepatol,2012,28(6):413-421.(in Chinese)胡晓丽,赵宏伟,吴晓岩,等.乙型肝炎病毒感染的流行现状[J].临床肝胆病杂志,2012,28(6):413-421.

[2]CHEN KL,CHEN J,RAO HL,et al.Hepatitis B virus reactivation and hepatitis in diffuse large B-cell lymphoma patients with resolved hepatitis B receiving rituximab-containing chemotherapy:risk factors and survival[J].Chin J Cancer,2015,34(1):18.

[3]LAW MF,LAI HK,CHAN HN,et al.The impact of hepatitis B virus(HBV)infection on clinical outcomes of patients with diffuse large B-cell lymphoma[J].Eur J Cancer Care(Engl),2015,24(1):117-124.

[4]IFUKU H,KUSUMOTO S,TANAKA Y,et al.Fatal reactivation of hepatitis B virus infection in a patient with adult T-cell leukemia-lymphoma receiving the anti-CC chemokine receptor 4 antibody mogamulizumab[J].Hepatol Res,2015.[Epub ahead of print]

[5]TANG SH,ZENG WZ,JIANG MD.American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy[J].J Clin Hepatol,2014,31(4):483-485.(in Chinese)汤善宏,曾维政,蒋明德.2014年美国胃肠病学会指南:免疫抑制剂治疗过程中HBV再激活的预防及治疗[J].临床肝胆病杂志,2014,31(4):483-485.

[6] YEO W,CHAN PK,ZHONG S,et al.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):299-307.

[7]WANG F,XU RH,LUO HY,et al.Clinical and prognostic analysis of hepatitis B virus infection in diffuse large B-cell lymphoma[J].BMC Cancer,2008,8:115.

[8]YEO W,CHAN PK,HO WM,et al.Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy[J].J Clin Oncol,2004,22(5):927-934.

[9]LI YH,HE YF,WANG FH,et al.Clinical analysis of liver damage of 116 malignant lymphoma patients with chronic HBV infection after cytotoxic chemotherapy[J].Chin J Cancer,2005,24(12):1507-1509.(in Chinese)李宇红,何义富,王风华,等.116例携带乙肝病毒的淋巴瘤患者化疗后发生肝功能损害的临床分析[J].癌症,2005,24(12):1507-1509.

[10]TOTANI H,KUSUMOTO S,ISHIDA T,et al.Reactivation of hepatitis B virus(HBV)infection in adult T-cell leukemia-lymphoma patients with resolved HBV infection following systemic chemotherapy[J].Int J Hematol,2015,101(4):398-404.

[11]QU Q,SHEN KW.Hepatitis B virus reactivation in patients receiving chemotherapy with breast cancer[J].Chin J Hepatol,2012,92(34):2377-2378.

[12]GUI HL,XIE Q.Diagnosis,management and prevention of hepatitis B virus reactivation during anticancer therapy[J].Chin J Hepatol,2007,15(1):78-80.(in Chinese)桂红莲,谢青.抗肿瘤治疗期间乙型肝炎再激活的诊断、治疗和预防[J].中华肝脏病杂志,2007,15(1):78-80.

[13]LOK AS,LIANG RH,CHIU EK,et al.Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy.Report of a prospective study[J].Gastroenterology,1991,100(1):182-188.

[14]PATTULLO V.Hepatitis B reactivation in the setting of chemotherapy and immunosuppression-prevention is better than cure[J].World J Hepatol,2015,7(7):954-967.

[15]ZHONG S,YEO W,SCHRODER C,et al.High hepatitis B virus(HBV)DNA viral load is an important risk factor for HBV reactivation in breast cancer patients undergoing cytotoxic chemotherapy[J].J Viral Hepat,2004,11(1):55-59.

[16]CHENG AL,HSIUNG CA,SU IJ,et al.Steroid-free chemotherapy decreases risk of hepatitis B virus(HBV)reactivation in HBVcarriers with lymphoma[J].Hepatology,2003,37(6):1320-1328.

[17]KIM E,YUNE S,HA JM,et al.Hepatitis B virus reactivation during anti-cancer chemotherapy in patients with past hepatitis B virus infection[J].Hepatogastroenterology,2014,61(134):1704-1711.

[18]CHU CM,LIAW YF.Genotype C hepatitis B virus infection is associated with a higher risk of reactivation of hepatitis B and progression to cirrhosis than genotype B:a longitudinal study of hepatitis B e antigen-positive patients with normal aminotransferase levels at baseline[J].J Hepatol,2005,43(3):411-417.

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