恶性肿瘤化疗与乙肝病毒再激活及相关高危因素的临床分析

目的探讨HBV感染的恶性肿瘤患者化疗后,乙型肝炎病毒(HBV)再激活及肝功能损害的发生情况及其与预后的关系。方法选择经组织学或细胞学检查确诊为恶性肿瘤且需化疗的患者80例,其中观察组40例,HbsAg阳性;对照组40例,HbsAg阴性,HBV-DNA阴性。结果观察组20.0%(8/40)患者出现乙肝病毒激活,化疗后HBV-DNA水平较化疗前增高(P<0.001);观察组化疗后肝功能损害发生率达57.5%(23/40),明显较对照组[27.0%(10/40)]高,P=0.033。化疗后HBV激活者肝功能损害较HBV非激活者明显,P<0.001。激素和蒽环类的应用,是乙肝病毒激活的高危因素。结论 HBV感染的癌症患者接受化疗时存在HBV激活,肝功能损害较非HBV感染者严重,激素与蒽环类的应用是HBV再激活的高危因素。

Hepatitis B Virus Reactivation and its Risk Factors in Patients with Malignant Tumors after Chemotherapy

Objective To investigate the hepatitis B virus（HBV） reactivation,the liver damage and the prognosis in cancer patients with Chronic HBV infection after chemotherapy.Methods 80 malignant patients diagnosed by histology or cytology,who need to treat with chemotherapy,were selected.40 patients with HbsAg positive were in the observation group and the other 40 patients with both HbsAg and HBV-DNA negative were in the control group.Results HBV reactivation appeared in 20%（8/40） patients in the observation group,HBV-DNA level was higher after chemotherapy than that before chemotherapy（P0.001）.In the observation group,the liver damage after chemotherapy was 57.5%（23/40）,with a significant higher to the control group（P=0.033）.Hormone or anthracycline treatment were risk factors of HBV reactivation.Conclusion HBV reactivation occurs in cancer patients with Chronic HBV infection receiving chemotherapy.Liver damage is significantly higher in patients with HBV infection.The high risk factors of HBV reactivation are hormones and anthracycline treatment.