拉米夫定预防肿瘤患者化疗后乙型肝炎的发作

目的:探讨拉米夫定预防合并乙型肝炎病毒(HBV)感染的恶性肿瘤患者化疗后肝炎发作的效果。方法:将38例患者随机分为对照组和治疗组各19例,治疗组在对照组常规保肝降酶治疗的基础上加拉米夫定100mg/d口服,观察两组化疗前后肝功能、血清HBV-DNA的动态变化,化疗延迟和中止率。结果:对照组化疗前血清总胆红素(TSB)为(18.1±4.3)μmol/L,化疗后峰值为(59.3±35.1)μmol/L;丙氨酸氨基转移酶(ALT)化疗前为(31.9±8.8)U/L,化疗后峰值为(417.2±185.1)U/L,化疗前后比较有显著性差异(P<0.05和P<0.01)。治疗组化疗前TSB为(17.9±3.8)μmol/L,化疗后峰值为(20.2±7.4)μmol/L;化疗前ALT为(33.7±7.5)U/L,化疗后峰值为(60.2±20.8)U/L,化疗前后比较无显著性差异(P>0.05)。对照组和治疗组化疗后TSB、ALT比较有显著性差异(P<0.05和P<0.01)。对照组HBV-DNA化疗后第3周始逐渐上升;治疗组则下降,阴转率第6周为60%,第18周达82%。对照组肝功能恶化17/19例(89.5%),需化疗剂量调整或延迟化疗7例,中止化疗3例,合计10例(52.6%);治疗组肝功能恶化3例(15.8%),需剂量调整1例(5.3%),两组比较有极显著性差异(P<0.01)。结论:拉米夫定可有效抑制恶性肿瘤并HBV感染患者HBV的复制,预防化疗后肝炎的发生。

Preventive Effect of Lamivudine to HBV Hepatitis of Tumor Patients with HBV Infection

Objective: To observe lamivudine's preventive effect to post-chemotherapy HBV hepatitis of tumor patients with HBV infection.Methods: Thirty-eight malignant tumor patients with HBV infection were divided into two groups randomly.Lamivudine 100 mg per day together with combined chemotherapy were given orally once daily in group A,meanwhile only combined chemotherapy was given in group B.Results:The peak values of total serum bilirubin(TSB) and alanine aminotransferase(ALT) before and after chemotherapy in group A were(17.9±3.8)μmol/L and(20.2±7.4) μmol/L(P> 0.05),(33.7±7.5)U/L and(60.2±20.8)U/L(P> 0.05);in group B were(18.1±4.3)μmol/L and(59.3±35.1)μmol/L(P< 0.05),(31.9±8.8)U/L and(417.2±185.1)U/L(P< 0.01),respectively.The peak values of TSB and ALT after chemotherapy in group A were of significant differences with that in group B.Three weeks after chemotherapy the HBV-DNA indexes gradually decreased in group A,but increased in group B.The negative rates of HBV-DNA index were 60% and 82% after lamivudine treatment for six weeks and eighteen weeks,respectively.Worse liver function values were observed in 3(15.8%) and 17(89.5%) patients in group A and B(P< 0.01).Chemotherapy postponement was observed in 1(5.3%) and 7(36.8%)patients in group A and B.Three patients in group B had to cease chemotherapy because of worse liver function(P<0.01).Conclusion: Lamivudine is effective in suppressing duplication of HBV-DNA in these tumor patients,and can prevent the onset of post-chemotherapy HBV hepatitis.