HBsAg阴性HBcAb阳性肿瘤患者化疗后HBV再激活3例报道并文献复习

目的：探讨乙肝表面抗原（HBsAg）（-）核心抗体（HBcAb）（+）肿瘤患者化疗后引起乙型肝炎病毒（HBV）再激活的治疗与监控。方法：报道3例HBsAg（-）HBsAg（+）的肿瘤患者化疗过程中出现HBV再激活的病例，针对可行的治疗监控措施进行文献复习。结果：1例最初乙肝表面抗体（HBsAb）（+）、HBcAb（+）的非霍奇金淋巴瘤（NHL）患者经过多次化疗后转变为HBsAg（+）、e抗原（HBeAg）(+)、HBcAb（+）；1例乙肝e抗体（HBsAb）（+）、HBcAb(+)的霍奇金淋巴瘤（NL）患者化疗后乙肝模式未改变，乙肝病毒载量（HBV-NDA）定量结果增高；1例HBsAb(+)、HBeAb(+)、HBcAb(+)的肝癌患者性肝动脉化疗栓塞术（TACE）后出现HBV-DNA定量结果增高。3例HBsAg(-)患者化疗后均出现HBV再激活，经抗病毒治疗后获得良好转归。结论：不仅对于HBsAg（+）的患者，对于即使处于康复期的既往有急性或慢性乙肝病史的HBsAg(-)、HBcAb（+）患者，在应用化疗或免疫抑制剂治疗时均需严密监测血清HBsAg、肝功能及HBV-DNA定量的动态变化，必要时实施预防性抗病毒治疗，以免中止原有治疗计划延误病情。

Reactivation of Hepatitis B Virus Infection after Chemotherapy in Cancer Patients with HBsAg(-)HBcAb(+) :Three Cases Reports and Literatures Review

Objective: To study the treatment and management for hepatitis B virus(HBV) reactivation after chemotherapy in cancer patients with HBsAg(-)HBcAb(+).Methods: This study presented three different cases of HBV reactivation after chemotherapy, and made a literatures review about possible prophylactic and therapeutic methods.Results:One non-Hodgkin lymphoma(NHL)patient with HBsAb(+)HBcAb(+) changed into HBsAg(+)HBeAg(+)HBcAb(+) after several cycles of chemotherapy.In another Hodgkin's lymphoma(HL) patient with HBeAb(+)、HBcAb(+), the HBV-DNA level was elevated after chemotherapy.The last HBsAb(+), HBeAb(+), HBcAb(+) hepatocellular carcinoma patient's HBV-DNA level was also elevated after the transarterial chemoembolization(TACE).The three patients of HBsAg(-)suffered from HBV reactivation during the chemotherapy, but all of them obtained good outcome following the antiviral therapy.Conclusion: The HBsAg, liver function and HBV-DNA level should be closely monitored during the procedure of chemotherapy or immunosuppressive therapy not only in the patients of HBsAg (+),but also in the HBsAg(-)HBcAb(+) patients who once suffered from acute hepatitis or chronic hepatitis infection.If necessary, the prophylactic use of antiviral therapy should be carried out in case the unexpected stop of the treatment regimen.