乳腺癌化疗HBV再激活患者肝功能水平及其影响因素

目的调查乳腺癌化疗患者乙型肝炎病毒(HBV)再激活和肝功能受损情况,分析影响HBV再激活的影响因素。方法选择2015年1月-2019年12月在焦作市人民医院及郑州大学第一附属医院(以下简称郑大一附院)接受化疗治疗的298例乳腺癌患者为研究对象,根据患者化疗期间是否发生HBV再激活,分为HBV激活组60例和HBV未激活组238例。回顾性分析两组患者入院的年龄、体质量指数(BMI)、化疗方案、是否使用激素治疗、基线乙型肝炎病毒e抗原(HBeAg)和基线HBV DNA等资料,归纳乳腺癌化疗患者HBV再激活的影响因素。分别于化疗前后,检测血清丙氨酸转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBiL)水平和HBsAg、乙型肝炎病毒核心抗体(HBcAb)、HBeAg和乙型肝炎病毒e抗体(HBeAb)滴度,实时荧光PCR法检测HBV DNA,评估患者的肝功能损伤。结果 298例乳腺癌患者化疗后出现HBV再激活60例(20.13%)。HBV激活组患者化疗后血清HBsAg滴度、HBeAg滴度、ALT、AST和TBiL高于化疗前(P<0.05);HBV激活组患者化疗后的HBsAg滴度、HBeAg滴度、ALT、AST和TBiL变化水平分别为(2 786.43±157.69)IU/ml、(64.87±6.15)IU/ml、(50.63±7.97)U/L、(44.72±6.82)U/L和(13.42±1.83)μmol/L,明显高于HBV未激活组(P<0.05);基线HBV DNA阳性(OR=1.992,P=0.025)、基线AST升高(OR=1.923,P=0.037)和基线ALT升高(OR=2.063,P=0.012)是乳腺癌化疗患者HBV再激活的影响因素(P<0.05)。结论乳腺癌化疗HBV再激活患者的肝功能损伤发生率明显升高,临床需重点关注化疗患者的肝功能和HBV DNA水平。

Analysis of HBV reactivation and liver function impairment in breast cancer patients undergoing chemotherapy and its influencing factors

OBJECTIVE To investigate the reactivation of hepatitis B virus(HBV) and liver function impairment in breast cancer patients undergoing chemotherapy, and to analyze the factors influencing HBV reactivation. METHODS A total of 298 breast cancer patients who underwent chemotherapy at Jiaozuo People′s Hospital and the First Affiliated Hospital of Zhengzhou University(hereinafter referred to Zhengda First Affiliated Hospital) from Jan. 2015 to Dec. 2019 were recruited as the research subjects. According to the presence or absence of HBV reactivation during chemotherapy, they were divided into 60 cases of HBV activation group and 238 cases of HBV non-activation group. The clinical data such as age of admission, body mass index(BMI), chemotherapy regimens, usage of hormone therapy, baseline hepatitis B virus e antigen(HBeAg) and HBV DNA of the two groups of patients were retrospectively analyzed, and the factors affecting HBV reactivation in breast cancer chemotherapy patients were summarized. Before and after chemotherapy, levels of serum alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin(TBiL) were detected by full-automatic biochemical analyzer. The titers of HBsAg, hepatitis B core antibody(HBcAb), HbeAg and hepatitis B virus e antibody(HBeAb) were detected by ELISA. HBV DNA was detected by real-time fluorescent PCR. The liver function impairment was evaluated. The influencing factors of HBV reactivation in patients undergoing breast cancer chemotherapy were analyzed by Logistic model. RESULTS HBV reactivation occurred in 60(20.13%) of 298 breast cancer patients after chemotherapy. The serum HBsAg titer, HBeAg titer, alt, AST and TBIL in the HBV activated group after chemotherapy were significantly higher than those before chemotherapy(P<0.05);the changes of HBsAg titer, HBeAg titer, alt, AST and TBIL before and after chemotherapy in the HBV activation group were(2 786.43±157.69) IU/ml,(64.87±6.15) IU/ml,(50.63±7.97)U/L,(44.72±6.82) U/L and(13.42±1.83) μ mol/L, respectively, significantly higher than those in HBV inactive group(P<0.05). Baseline HBV DNA positive(OR=1.992, P=0.025), elevated baseline AST(OR=1.923, P=0.037) and elevated baseline ALT(OR=2.063, P=0.012) were the influencing factors of HBV reactivation in breast cancer patients undergoing chemotherapy(P<0.05). CONCLUSION The incidence of liver function damage in patients with HBV reactivation undergoing breast cancer chemotherapy was significantly increased, and clinical attention should be paid to the liver function and HBV DNA level in patients undergoing chemotherapy.