核苷类似物防治乙型肝炎表面抗原阳性的肿瘤患者化疗后乙型肝炎病毒再激活的临床分析

目的 探讨应用核苷类似物防治乙型肝炎表面抗原(HBsAg)阳性的非肝脏肿瘤患者化学治疗后乙型肝炎病毒(HBV)再激活的疗效.方法 回顾性分析58例HBsAg阳性肿瘤患者的治疗及结果 .58例患者分为预防组和对照组,预防组于化疗前预防性使用核苷类似物抗HBV治疗,比较两组HBV再激活的发生情况;对照组根据化疗后使用抗HBV药物与否及使用时段,比较未用抗HBV药物者(A组)、HBV再激活后方使用抗HBV药物者(B组)和尚未发生HBV再激活即使用抗HBV药物者(C组)之间的病情发展、转归及疗效等.结果 预防组22例患者中,仅3例(13.6%)发生HBV再激活,且肝炎发病程度明显轻于对照组,无重型肝炎及死亡病例.对照组36例患者中,22例(61.1%)发生HBV再激活,重型肝炎发病率(27.8%)和死亡率(16.7%)均高于预防组,肝功能损害程度亦高于预防组.在对照组中,A组5例患者均因肝功能衰竭死亡;B组13例患者中,4例发展为重型肝炎,其中1例死亡;C组18例患者中,4例出现HBV再激活,但其肝炎发病程度、病情转归、疗效均优于B组.结论 HBsAg阳性的肿瘤患者接受化疗前即预防性使用核苷类似物抗HBV治疗可有效减少HBV再激活概率.若已行化疗,及时加用核苷类似物抗HBV治疗,仍可在很大程度上减少HBV再激活的概率.即使已经出现HBV再激活,加用核苷类似物也有助于患者肝功能的恢复,改善预后.

Analysis of the prophylactic effect of nucleosides against reactivation of HBV in HBsAg-positive patients with non-hepatic tumors after chemotherapy

Objective To investigate the efficacy of nucleosides as a prophylactic agent against reactivation of hepatitis B virus ( HBV) in HBsAg-positive patients with non-hepatic tumors after chemotherapy. Methods Fifty-eight patients with non-hepatic tumors were divided into prevention group and control group.The patients of prevention group received nucleosides as a prophylactic agent before chemotherapy and were compared with the control ones about the clinical manifestation of HBV reactivation. Then, the patients of the control group were divided into three groups according to antiviral drugs, use or not and time of the use.The patients having HBV reactivation but never received nucleosides were included in the group A, the patients receiving nucleosides after having HBV reactivation were divided into the group B, and the patients receiving nucleosides before HBV reactivation were divided into tke group C. The progression, prognosis and curative effect among the three groups were compared.Results The rate of HBV reactivation, incidence of severe hepatitis, mortality rate of the control group (61. 1% , 27. 8% , 16.1% ) were significantly higher than those of the prevention group (13.6% , 0, 0) , and liver dysfunction was more serious than that in the prevention group. In the control group, all the 5 patients of group A died of liver failure.Of the 13 patients in the group B, 4 cases suffered from severe hepatitis and 1 of them died of the disease. Of the 18 patients in the group C, 4 cases suffered from HBV reactivation, but the clinical manifestation was milder than that of the group B. Conclusion Nucleosides can be used as a prophylactic measure to prevent HBV reactivation. If chemotherapy had begun, the use of nucleosides may reduce the risk of HBV reactivation. Even if patients had suffered from HBV reactivation, the use of nucleosides may still help the recovery of liver function and improve prognosis.