肿瘤患者化疗后乙型肝炎病毒再激活病例临床分析

A clinical analysis of HBV reactivation in patients with malignant tumors

目的观察肿瘤合并慢性HBV携带者化疗后HBV再激活抗病毒治疗的效果及化疗前预防性抗病毒用药对HBV再激活的预防作用。方法采用回顾性分析将13例肿瘤合并慢性HBV携带者分成两组：治疗性用药组8例，为化疗后HBV再激活致肝功能异常者，均停用原有化疗药物，给予拉米夫定100mg／d及保肝药治疗。预防性用药组5例，化疗前即予以拉米夫定100mg／d治疗，待血清HBV DNA水平降至〈10^3拷贝／ml之后再行化疗。随访两组患者的肝功能、HBV DNA水平及预后。结果8例化疗后HBV再激活者，出现肝功能异常后才给予拉米夫定抗病毒治疗，5例因肝功能衰竭而死亡，3例经抗病毒治疗后肝功能恢复，但推迟甚至终止了化疗。5例在化疗前接受预防性抗病毒治疗的患者中未观察到HBV再激活现象，无死亡病例。结论对于需要化疗的HBV携带者，预防比治疗更有意义。

Objective To observe the anti-viral therapy effect on HBV reactivation in malignant tumor patients and hepatitis B virus carriers after their cancer chemotherapy. Methods Thirteen cancer patients but also chronic hepatitis B virus carriers were enrolled in this study. They were randomly put into two groups. Eight patients were put in the therapeutic group. They all had abnormal liver functions induced by the reactivation of HBV after their cancer chemotherapy. Then they were treated with lamivudine. The other 5 cases were treated with lamivudine before their cancer chemotherapy when their serum HBV DNA levels were 〈10^3 copies/ml （preventive therapeutic group）. The two groups were followed-up with liver function tests and serum HBV DNA level measurements. Results Among the 8 cases of the therapeutic group, 5 cases died of liver failure; cancer chemotherapy was postponed or even terminated in 3 patients due to liver function abnormality and anti-virus treatment was started. In the preventive therapy group, no HBV reactivation was observed in any of the 5 cases. Conclusion For HBV carrier cancer patients, an anti-viral therapy before their cancer chemotheranv seems to be very imnortant.