利妥昔单抗治疗B细胞非霍奇金淋巴瘤合并乙肝病毒感染的临床观察

目的：探讨利妥昔单抗联合化疗治疗乙肝表面抗原阳性B细胞非霍奇金淋巴瘤患者的安全性和有效性。方法：回顾性分析2007年5月-2012年5月年收治的14例应用利妥昔单抗联合化疗治疗的乙肝表面抗原阳性B细胞淋巴瘤患者病例资料，观察联合化疗的疗效，肝功能情况及肝功异常时的治疗情况。结果：（1）14例患者总有效率（CR＋PR）78．57％（CR完全缓解．PR部分缓解），CR率42．86％．无效或进展3例．占21．43％。（2）14例患者中有4例化疗后出现Ⅰ-Ⅱ级肝功能异常，但HBV-DNA拷贝数未见明显上升。2例出现Ⅲ级肝功能损伤，ALT及AST明显上升，并伴有HBV-DNA拷贝数明显上升。经给予保肝及抗病毒治疗后肝功能恢复正常．HBV-DNA拷贝数降至正常。所有病例均未出现不可控制的肝功能损伤。结论：利妥昔单抗联合化疗治疗CD20阳性非霍奇金淋巴瘤CNHL）疗效确切．乙肝表面抗原阳性的NHL患者应用R-CHOP方案治疗存在乙肝病毒再激活风险．在化疗前后给予足疗程的抗病毒治疗，可降低HBV再激活风险，减少肝功能损害。

Clinical Observation of Rituximab Combination Chemotherapy Treated B cell non hodge lymphoma and Reactivation of Hepatitis B Virus

Objective： To investigate the efficacy and safety of rituximab combined with chemotherapy in treatment of B-cell lymphoma patients with positive HBV surface antigen（HBsAg）. Methods： Records of 14 B-cell lymphoma patients with positive HBV surface antigen（HBsAg）after rituximab combined chemotherapy from May 2007 to May 2012 in Xijing Hospitol were reviewd, and the effectiveness of combined chemotherapy, situation of liver function and treatment effectiveness under abnormal liver fimction were analyzed. Results：（1）Among the 14 cases, the total effective rate（CR＋PR）was 78.57%. The complete CR rate was 42.86%. The inefficiency rate was 21.43%（3/12 patients）.（2）Among the 14 patients, 4 patients suffered from grade Ⅰ-Ⅱ dysfunction of liver after the second and the third chemotherapy periods without obvious increase of HBV-DNA copy; 2 patients suffered from grade Ⅲ hepatic injury with obvious rise of ALT and AST, and obvious increase of HBV-DNA copy. The liver functions of these 2 patients returned to normal and the HBV-DNA fall back to normal after the liver-protecting treatment and antiviral therapy. All of the 14 patients, no one suffered from any uncontrollable hepatic injury. Conclusions： Using rituximab combined chemotherapy to treat CD20 positive non-Hodgkins lymphoma（NHL）can reach stable effect. The NHL patients suffering from HBV may suffer from recidivation of HBV if being treatedwith R-CHOP method. However, if they are subjected to enough treatment course of antivirus therapy before and after the chemotherapy, the risk of HBV recidivation may be cut down, and the injury of the liver may be cut down.