CHOP方案治疗NHL合并HBV携带者肝功能损害的探讨

目的观察CHOP方案治疗非霍奇金淋巴瘤（NHL）合并HBV携带者肝功能损害及肝炎病毒活化的情况。方法62例入选患者按HBV携带与否分为HBV携带组及非HBV携带组，两组患者均以CHOP方案正规化疗，3周重复，至少2周期。第一个周期化疗前及每次化疗后第3周末检测肝功能全套，HBV携带患者于第一个周期化疗前及每2周期化疗后第3周末检测血清HBV—DNA水平，所有患者均于出现肝功能损害后依病情加用非特异性保肝药物。结果化疗4及6周期后HBV携带组患者肝损害发生率均显著高于非HBV携带患者（P〈O．05），而且HBV携带组患者中肝损害发生率随治疗时间推移有上升趋势，化疗6周期后肝损害发生率显著高于化疗2周期后（P〈0．05）；化疗后血清HBVDNA阳性率有所升高，化疗6周期后血清HBVDNA阳性率显著高于2周期化疗后（P〈0．01），与4周期化疗后比较，差异无统计学意义（P〉0．05）。结论CHOP方案治疗非霍奇金淋巴瘤合并HBV携带患者，易发生肝功能损害，HBV复燃几率增加。积极的预防和治疗必不可少。

To study the liver function in HBsAg-positive non-Hodgkin Igmphoma paitent after CHOP chemotherapy

Objective To observe lesion to liver function and reactivation of HBV in HbsAg positive nonHodgkin lymphoma patient after CHOP chemotherapy. Methods There 62 nonHodgkin lymphoma cases which were hospitalized in our hospital from 2004 to 2007 were collected including 26 HBV carriers (HBsAg-Positive group),36 cases negative for HBV (non-HBsAg-positive group). All patients were treated with CHOP chemotherapy, at least two cycles. The liver function was monitored before chemotherapy and at end of the third week of every cycle. Serially collected serum samples were analyzed for serum HBV DNA before chemotherapy and at end of the third week of every two cycle in HBsAg-positive group. All patients with abnormal liver function after chemothrapy were given liver protectant. Results The percentage of patients with abnormal liver function increase significantly in HBsAg-positive group more than that of non-HBsAg-positive group afer four and six cycles of chemothrapy (P<0.05); In HBsAg-positive group, the percentage of patients with abnormal liver function was significantly increased after six cycles of chemothrapy higher than that of two cycles chemothrapy (P < 0.05). The positive percentage of serum HBVDNA afer six cycles of chemothrapy was higer than that of two cycles of chemothrapy (P < 0.01)in HBsAg-positive group. There were no dierences significantly in the positive percentage of serum HBVDNA between six and four cycles chemothrapy (P>0.05). Conclusions Lesions to liver function of HBsAg-positive nonHodgkin lymphoma patients after CHOP chemotherapy may occur easily and the risk of reactivation of HBV may increase, and active precaution measueres be taken.