乙肝表面抗原阳性淋巴瘤患者19例利妥昔单抗联合化疗肝功能损害分析

Clinical analysis of liver damage of malignant lymphoma patients with positive HBV surface antigen （HBsAg） after rituximab and chemotherapy

目的探讨利妥昔单抗（商品名：美罗华）联合化疗对乙肝表面抗原阳性（HBsAg^＋）淋巴瘤患者肝功能的影响。方法回顾性分析2001年6月至2007年8月病理确诊B细胞非霍奇金淋巴瘤伴HBsAg^＋的19例住院患者的临床资料。所有患者均接受利妥昔单抗联合化疗，参照WHO不良反应评价标准对治疗后肝功能损害进行分析。同时检测了部分患者的HBV—DNA，并分析其与治疗后肝功能损害的关系。结果19例患者中有12例（63．2％）发生了，肝功能损害。4例（21．1％）患者发生了Ⅰ度肝功能损害，6例（31．2％）患者发生了Ⅱ度肝功能损害，2例（10．5％）患者发生了Ⅲ度肝功能损害。无一例患者发生Ⅳ度肝功能损害？治疗前HBV—DNA〉10^7copy／ml的患者6例中有5例（83．3％）发生了肝功能损害，而治疗前HBV—DNA〈10^4copy／ml的患者5例中有3例（60％）发生了肝功能损害。结论HBsAg^＋淋巴瘤患者接受利妥昔单抗联合化疗后发生肝功能损害的概率较高：HBsAg^＋淋巴瘤患者应用利妥昔单抗时应该慎重，并进行抗乙肝病毒的治疗.

Objective To investigate the prevalence of liver damage in B-cell lymphoma patients with positive HBV surface antigen （HBsAg） after fituximab and chemotherapy. Methods Records of 19 B- cell lymphoma patients with positive HBV surface antigen （HBsAg） after rituximab and chemotherapy from June, 2001 to Aug, 2007 in Beijing Cancer Hospital were reviewed to analyze the prevalence of liver damage. At the same time, the relationship between the level of HBV-DNA and the damage of liver was analysed. Results According to WHO criteria of liver toxicity, of the 19 patients, 12 （63.2 %） suffered liver damage, 4（21.1%） patients in grade Ⅰ, 6 （31.2 %） patients in grade Ⅱ and 2（10.5 %） patients in grade Ⅲ. None of the patients in this study experienced grade Ⅳ liver toxicity. Of the 6 patients with HBV-DNA〉10^4copy/ml before therapy, 5 （83.3 %） suffered liver damage. Of the 5 patients with HBV-DNA〈10^4 copy/ml before therapy, 3 （60 %）suffered liver damage. Conclusion The prevalence of liver damage is higher in B-cell lymphoma patients with positive HBsAg after rituximab and chemotherapy. These patients should be closely monitored for liver function when they received rituximab therapy and should reveive anti-HBV therapy.