淋巴瘤患者化疗期间预防性抗乙肝病毒治疗的策略分析

目的研究伴有慢性HBV感染的淋巴瘤患者化疗期间预防性抗病毒治疗的必要性和用药选择。方法同顾性分析23例伴有慢性HBV感染的淋巴瘤患者的临床资料,并分析其预防用药方案和效果。结果 23例患者巾22例选择了预防性抗HBV药物,其中1例因继发急性淋巴细胞白血病死亡,其余患者顺利完成化疗。治疗过程中ALT升高6例,其中1例换用恩替卡韦、5例继续应用拉米夫定ALT渐降至正常。化疗前HBV-DNA阳性的15例患者,其中5例至化疗结束始终阳性,10例化疗1～3个月转为阴性;化疗前HBV-DNA阴性的8例患者,其中4例至化疗结束始终阴性,4例出现HBV-DNA复制。结论伴有慢性HBV感染的淋巴瘤患者在化疗的同时预防性选择抗病毒药物非常必要。对于初始选用拉米夫定的患者,如果HBV-DNA为阴性或者服药后在3个月内得到良好应答,可继续服用,但要密切进行监测HBV-DNA和ALT变化。如果患者条件允许,初始治疗即服用恩替卡韦或许是更好的选择。

The prophylactic anti-HBV treatment strategy for lymphoma patients during Chemotherapy

Objective To analyse the necessity and drug choice of prophylactic anti-HBV treatment in lymphoma patients with chronic hepatitis B virus infection.Methods Retrospective analyzed the initial presentation of 23 cases lymphoma patients with chronic hepatitis B virus infection,and investigate the prophylactic drug choice and effectiveness.Results 22 cases were selected the prophylactic drug in all of the 23 cases.One case died because of secondary acute lymphoblastic leukemia and others completed the chemotherapy.ALT increased in 6 cases during treatment.It was gradually reduced to normal level after switching to entecavir in one case and maintaining the original program in others.There were 15 HBV-DNA positive cases before chemotherapy,5 cases maintained positive to the end of chemotherapy and others converted to negative after 1 to 3 months.There were 8 HBV-DNA negative cases before chemotherapy,4 cases maintained negative to the end of chemotherapy and others occurred to viral replication.Conclusion The prophylactic anti-HBV treatment strategy was necessary when chemotherapy were applied to lymphoma patients with chronic HBV infection.The lamivudine could be used continually if the HBV-DNA was negative or had a good response within three months.But it’s necessary to monitor HBV-DNA and ALT.The entecavir would be the better choice for the initial treatment if patient condition was allowed.