乙肝表面抗原阴性恶性肿瘤患者化疗后乙肝病毒再激活的影响因素

 目的 探讨乙肝表面抗原(hepatitis B surface antigen,HBsAg)阴性恶性肿瘤患者化疗后乙肝病毒(hepatitis B virus,HBV)再激活的相关危险因素。方法 收集2006-01至2014-12在武警上海总队医院接受化疗的HBsAg阴性恶性肿瘤患者570例。根据化疗后HBV是否出现再激活将患者分为再激活组25例及未被激活组545例,回顾性分析两组患者一般情况、化疗方案及实验室检查指标,对HBV再激活的潜在影响因素进行χ²检验及Logistic回归分析。结果 单因素分析表明两组患者在性别、乙肝表面抗体状态、e抗体状态、核心抗体状态及是否使用免疫抑制药方面差异有统计学意义(P<0.05),将其纳入多因素非条件Logistic回归分析,结果提示男性(OR=7.700,P<0.001)、乙肝表面抗体阴性(OR=0.056, P<0.001)、核心抗体阳性(OR=4.670, P<0.01)及使用免疫抑制药(OR=7.978, P<0.01)是导致化疗后HBV再激活的独立危险因素。结论 对于男性、乙肝表面抗体阴性、核心抗体阳性及使用免疫抑制药的HBsAg阴性的恶性肿瘤患者行化疗时,应密切监测HBV是否出现再激活或及早采取抗病毒治疗防止HBV再激活。

Influencing factors of hepatitis B virus reactivation after chemotherapy in hepatitis B surface antigen negative patients with malignant carcinoma

Objective To investigate the occurrence of the related risk factor hepatitis B virus (HBV) reactivation after chemotherapy in hepatitis B surface antigen (HBsAg) negative patients with malignant carcinoma. Methods A total of five hundred and seventy HBsAg-negative patients with malignant carcinoma who received chemotherapy were recruited during the period of 2006-01 to 2014-12 in Shanghai Corps Hospital of Chinese People’s Armed Police Force. The patients were divided into reactivation group (n=25) and inactivation (n=545) group according to whether the virus was reactivated after chemotherapy. The general information, chemotherapy regimen and index of laboratory examination in both groups were analyzed retrospectively,2 test and logistic regression analysis were performed on potential influencing factors for HBV reactivation. Results The univariate analysis indicated that gender, hepatitis B surface antibody status, e antibody status, core antibody status and whether or no application of immune suppression were statistically significantly different between the two groups. The multivariate non-conditioned logistic regression analysis of these five factors indicated that male (OR=7.700, P＜0.001), hepatitis B surface antibody negative (OR=0.056, P＜0.001), E antibody positive (OR=4.670, P＜0.01) and application of immune suppression (OR=7.978, P＜0.01) were independent risk factors for HBV reactivation after chemotherapy. Conclusions For male, surface antibody negative, core antibody positive and application of immune suppression of HBsAg negative patients with malignant carcinoma, chemotherapy should closely monitor HBV whether reactivation or take early antiviral treatment to prevent HBV reactivation.