血液病患者治疗后乙型肝炎病毒再激活的临床研究

CIinical study on hepatitis B virus reactivation after treatment of hematology

目的观察血液病患者经过化疗及免疫抑制治疗后,乙型肝炎病毒(HBV)再激活情况及拉米夫定对其治疗作用。方法收集2005年1月至2010年1月在本院进行治疗的携带HBV的血液系统疾病患者62例,统计HBV再激活以及再激活后肝炎发生情况,并根据拉米夫定使用情况将其分为未预防组(n=50)和拉米夫定预防组(n=12),检测两组化疗前后天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素、白蛋白(ALB)、HBV DNA水平。结果 62例患者中,治疗后HBV激活并发肝损害的有21例(33.9%)。治疗前两组的AST、ALT、总胆红素、ALB比较差异均无统计学意义,HBV DNA水平未预防组显著低于拉米夫定预防组;治疗后拉米夫定预防组的患者8.3%出现肝功能异常,而未预防组为40.0%(P<0.01),同时未预防组的AST、ALT和HBV DNA水平明显增高(P<0.01),而总胆红素和ALB无明显变化。结论化疗和免疫抑制治疗可使HBV再激活,拉米夫定可预防和治疗HBV感染的血液病患者化疗后病毒的重新激活,且不良反应较小。

Objective To observe the clinical study on reactivation of hepatitis B virus（HBV） in patients with hematologic disease which were subjected to chemotherapy or immune suppressive therapy.And to evaluate the use of lamivudine as prophylaxis for HBV reactivation in patients undergoing chemotherapy or immunosuppressive therapy.Methods 62 HBV type hepatitis patients with hematologic disease in the hospital were subjected to chemotherapy or immunosuppressive therapy according to the standard international guidelines from Jan,2003 to Jan,2008.Of 62 cases,50 patients received chemotherapy or immunosuppressive therapy alone（group A）,the other 12 patients received chemotherapy or immunosuppressive therapy plus lamivudine as preservation（group B）.The liver function indexes including aspartate aminotransterase（AST）,alanine aminotransterase（ALT）,total bilirubin,albumins（ALB）,HBV DNA level were checked before and after chemotherapy or immunosuppressive therapy treatment.Results Before treatment,no significant difference was observed in the liver function indexes（AST,ALT,total bilirubin,ALB） between two groups.The HBV DNA level was significantly lower in group A.After treatment,8.3% patients in group A and 40.0% patients in group B had abnormal liver function indexes（P〈0.01）.Group A had lower level of AST,ALT and HBV DNA than group B（P〈0.01）.The total bilirubin and albumin level did not show significant difference between two groups.No significant poisonous effect and side-effect occurred in group B.Conclusion HBV reactivation can be induced by chemotherapy and immunosuppressive therapy.Lamivudine may obviate and improve HBV reactivation with less poisonous effect and side effect.