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

背景与目的:有研究显示,携带慢性乙型肝炎病毒(hepatitisBvirus,HBV)的恶性肿瘤患者化疗后肝功能损害发生率及相关死亡率明显增加。本研究探讨携带慢性HBV的淋巴瘤患者接受化疗后,肝功能损害的发生情况及其临床后果,并进一步探讨临床相关的高危因素。方法:1985年1月至2002年1月在我院门诊及住院的携带HBV的116例淋巴瘤患者,回顾性分析其接受化疗后肝功能损害的发生情况、临床后果及其相关高危因素。结果:60例(51.7%)患者化疗后出现肝功能损害,按WHO肝脏毒性标准,Ⅰ度4例(3.4%)、Ⅱ度14例(12.1%)、Ⅲ度15例(12.9%)、Ⅳ度27例(23.3%)。经对症治疗后11例(9.5%)患者按期化疗,27例(23.3%)化疗延期,16例(13.8%)终止化疗,6例(5.2%)死亡。应用二值多元logistic回归模型,应用激素是化疗后发生肝炎的高危因素。结论:携带HBV的淋巴瘤患者化疗后肝功能损害发生率高,化疗后肝功能损害会导致患者化疗延迟,甚至死亡。应用激素是其发生的高危因素。

Clinical analysis of liver damage of 116 malignant lymphoma patients with chronic HBV infection after cytotoxic chemotherapy

BACKGROUND & OBJECTIVE: Chronic hepatitis B virus (HBV) infection increases the prevalence of liver damage and related death of malignant tumor patients. This study was to investigate the prevalence of liver damage and clinical results in lymphoma patients with chronic HBV infection after standard chemotherapy, and assess high risk factors associated with liver damage for better guidance in clinic. METHODS: Records of 116 lymphoma patients with chronic HBV infection, treated with standard chemotherapy from Jan. 1985 to Jan. 2002 in Cancer Center of Sun Yat-sen University, were reviewed to analyze the prevalence of liver damage, clinical results, and related high risk factors. RESULTS: Of the 116 patients, 60 (51.7%) suffered liver damage. According to WHO criteria of liver toxicity, 4 (3.4%) were in grade I, 14 (12.1%) in grade II, 15 (12.9%) in grade III, and 27 (23.3%) in grade IV. After treatment for liver damage, 11 (9.5%) patients completed chemotherapy without delay, 27(23.3%) completed chemotherapy with delay of more than 8 days, 16(13.8%) terminated chemotherapy, 6(5.2%) died. Logistic multivariate analysis showed that steroid was a high risk factor of liver damage after chemotherapy. CONCLUSIONS: The prevalence of liver damage is high in lymphoma patients with chronic HBV infection after standard chemotherapy, which led to treatment delay or discontinue, even death. Steroid is a high risk of liver damage.